Provider Demographics
NPI:1326692443
Name:TAYLOR, TOMMY W (RPH)
Entity Type:Individual
Prefix:MR
First Name:TOMMY
Middle Name:W
Last Name:TAYLOR
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2809 S MAYHILL RD
Mailing Address - Street 2:
Mailing Address - City:DENTON
Mailing Address - State:TX
Mailing Address - Zip Code:76208-5910
Mailing Address - Country:US
Mailing Address - Phone:940-239-3051
Mailing Address - Fax:
Practice Address - Street 1:2809 S MAYHILL RD
Practice Address - Street 2:
Practice Address - City:DENTON
Practice Address - State:TX
Practice Address - Zip Code:76208-5910
Practice Address - Country:US
Practice Address - Phone:940-239-3051
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-07-26
Last Update Date:2019-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX30900183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist