Provider Demographics
NPI:1073035861
Name:TAYLOR, BROCK HARDY (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:BROCK
Middle Name:HARDY
Last Name:TAYLOR
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:744 WESLEY CHAPEL RD
Mailing Address - Street 2:
Mailing Address - City:LAWRENCEBURG
Mailing Address - State:TN
Mailing Address - Zip Code:38464-6207
Mailing Address - Country:US
Mailing Address - Phone:931-242-7572
Mailing Address - Fax:
Practice Address - Street 1:312 E GAINES ST
Practice Address - Street 2:
Practice Address - City:LAWRENCEBURG
Practice Address - State:TN
Practice Address - Zip Code:38464-3532
Practice Address - Country:US
Practice Address - Phone:931-762-6840
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-07-13
Last Update Date:2017-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN41201183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist