Provider Demographics
NPI:1285222786
Name:TAYLOR, BRYAN (PHARMD)
Entity Type:Individual
Prefix:
First Name:BRYAN
Middle Name:
Last Name:TAYLOR
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:119 CHESTNUT ST APT 15
Mailing Address - Street 2:
Mailing Address - City:OXFORD
Mailing Address - State:MS
Mailing Address - Zip Code:38655-3428
Mailing Address - Country:US
Mailing Address - Phone:662-292-1515
Mailing Address - Fax:
Practice Address - Street 1:145 E VAN DORN AVE
Practice Address - Street 2:
Practice Address - City:HOLLY SPRINGS
Practice Address - State:MS
Practice Address - Zip Code:38635-3096
Practice Address - Country:US
Practice Address - Phone:662-252-2331
Practice Address - Fax:662-252-1656
Is Sole Proprietor?:No
Enumeration Date:2021-01-10
Last Update Date:2021-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSE-13010183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist