Provider Demographics
NPI:1376840447
Name:TAYLOR, MARTHA WESSINGER (REGISTERED PHARMACIS)
Entity Type:Individual
Prefix:MRS
First Name:MARTHA
Middle Name:WESSINGER
Last Name:TAYLOR
Suffix:
Gender:F
Credentials:REGISTERED PHARMACIS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:814 E MAIN ST
Mailing Address - Street 2:
Mailing Address - City:LAURENS
Mailing Address - State:SC
Mailing Address - Zip Code:29360-3535
Mailing Address - Country:US
Mailing Address - Phone:864-984-5283
Mailing Address - Fax:864-984-5403
Practice Address - Street 1:814 E MAIN ST
Practice Address - Street 2:
Practice Address - City:LAURENS
Practice Address - State:SC
Practice Address - Zip Code:29360-3535
Practice Address - Country:US
Practice Address - Phone:864-984-5283
Practice Address - Fax:864-984-5403
Is Sole Proprietor?:Yes
Enumeration Date:2011-02-24
Last Update Date:2011-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC4370183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist