Provider Demographics
NPI:1093829079
Name:PAUL TAYLOR INC
Entity Type:Organization
Organization Name:PAUL TAYLOR INC
Other - Org Name:TAYLOR MEDICAL PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:PAUL
Authorized Official - Middle Name:
Authorized Official - Last Name:TAYLOR
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:704-664-8950
Mailing Address - Street 1:114 SURFSIDE LN
Mailing Address - Street 2:
Mailing Address - City:MOORESVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28117-7464
Mailing Address - Country:US
Mailing Address - Phone:704-664-8950
Mailing Address - Fax:704-664-1999
Practice Address - Street 1:6360 E NC 150 HWY
Practice Address - Street 2:
Practice Address - City:SHERRILLS FORD
Practice Address - State:NC
Practice Address - Zip Code:28673-9404
Practice Address - Country:US
Practice Address - Phone:704-483-9150
Practice Address - Fax:704-664-1999
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-18
Last Update Date:2009-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
332B00000X, 3336S0011X
NC092693336M0002X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336M0002XSuppliersPharmacyMail Order Pharmacy
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No3336S0011XSuppliersPharmacySpecialty Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
3405948OtherNCPDP PROVIDER IDENTIFICATION NUMBER
NC7704471Medicaid
NC7704471Medicaid