Provider Demographics
NPI:1093845638
Name:TAYLOR, DONALD RICHARD (RPH)
Entity Type:Individual
Prefix:MR
First Name:DONALD
Middle Name:RICHARD
Last Name:TAYLOR
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:DONALD
Other - Middle Name:RICHARD
Other - Last Name:TAYLOR
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:RPH
Mailing Address - Street 1:2581 SE GRAND DR
Mailing Address - Street 2:
Mailing Address - City:PORT ST LUCIE
Mailing Address - State:FL
Mailing Address - Zip Code:34952-7129
Mailing Address - Country:US
Mailing Address - Phone:772-335-3240
Mailing Address - Fax:
Practice Address - Street 1:622 COLORADO AVE
Practice Address - Street 2:
Practice Address - City:STUART
Practice Address - State:FL
Practice Address - Zip Code:34994-3016
Practice Address - Country:US
Practice Address - Phone:772-287-3443
Practice Address - Fax:772-287-0087
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS12956183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist