Provider Demographics
NPI:1114511888
Name:POOLE, TAYLER LEEANN
Entity Type:Individual
Prefix:
First Name:TAYLER
Middle Name:LEEANN
Last Name:POOLE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:TAYLER
Other - Middle Name:POOLE
Other - Last Name:CROSBY
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PHARMD
Mailing Address - Street 1:401 NORTH DUVAL STREET
Mailing Address - Street 2:
Mailing Address - City:CLAXTON
Mailing Address - State:GA
Mailing Address - Zip Code:30417
Mailing Address - Country:US
Mailing Address - Phone:912-739-1327
Mailing Address - Fax:
Practice Address - Street 1:401 N DUVAL ST
Practice Address - Street 2:
Practice Address - City:CLAXTON
Practice Address - State:GA
Practice Address - Zip Code:30417-5939
Practice Address - Country:US
Practice Address - Phone:912-739-1327
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-02-23
Last Update Date:2021-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARPH032473183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist