Provider Demographics
NPI:1275056509
Name:TAYLOR, COREY MICHAEL
Entity Type:Individual
Prefix:MR
First Name:COREY
Middle Name:MICHAEL
Last Name:TAYLOR
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:66 COURT ST APT C
Mailing Address - Street 2:
Mailing Address - City:BANGOR
Mailing Address - State:ME
Mailing Address - Zip Code:04401-4765
Mailing Address - Country:US
Mailing Address - Phone:207-812-8257
Mailing Address - Fax:
Practice Address - Street 1:66 COURT ST APT C
Practice Address - Street 2:
Practice Address - City:BANGOR
Practice Address - State:ME
Practice Address - Zip Code:04401-4765
Practice Address - Country:US
Practice Address - Phone:207-812-8257
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-07-19
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEPI45625183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist