Provider Demographics
NPI:1023396660
Name:TAYLOR, SETH REILLY (RPH)
Entity Type:Individual
Prefix:MR
First Name:SETH
Middle Name:REILLY
Last Name:TAYLOR
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:30 SILKWOOD
Mailing Address - Street 2:
Mailing Address - City:ALISO VIEJO
Mailing Address - State:CA
Mailing Address - Zip Code:92656-2122
Mailing Address - Country:US
Mailing Address - Phone:949-360-6141
Mailing Address - Fax:
Practice Address - Street 1:13200 JAMBOREE RD
Practice Address - Street 2:
Practice Address - City:IRVINE
Practice Address - State:CA
Practice Address - Zip Code:92602-2307
Practice Address - Country:US
Practice Address - Phone:714-838-7433
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-08-01
Last Update Date:2011-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA46319183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist