Provider Demographics
NPI:1073866281
Name:NELSON, TAYLOR MARIE (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:TAYLOR
Middle Name:MARIE
Last Name:NELSON
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:93 STONEBROOK PL
Mailing Address - Street 2:T-0921
Mailing Address - City:JACKSON
Mailing Address - State:TN
Mailing Address - Zip Code:38305-3637
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:93 STONEBROOK PL
Practice Address - Street 2:T-0921
Practice Address - City:JACKSON
Practice Address - State:TN
Practice Address - Zip Code:38305-3637
Practice Address - Country:US
Practice Address - Phone:731-660-2845
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-10-25
Last Update Date:2012-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN0000036951183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist