Provider Demographics
NPI:1346840279
Name:TAYLOR, TANYA LEIGH (RPH)
Entity Type:Individual
Prefix:
First Name:TANYA
Middle Name:LEIGH
Last Name:TAYLOR
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:304 S ROCKWOOD DR
Mailing Address - Street 2:
Mailing Address - City:CABOT
Mailing Address - State:AR
Mailing Address - Zip Code:72023-2881
Mailing Address - Country:US
Mailing Address - Phone:501-941-1778
Mailing Address - Fax:
Practice Address - Street 1:316 HIGHWAY 319 E
Practice Address - Street 2:
Practice Address - City:VILONIA
Practice Address - State:AR
Practice Address - Zip Code:72173-9574
Practice Address - Country:US
Practice Address - Phone:501-681-2372
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-10-29
Last Update Date:2020-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR07892183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist