Provider Demographics
NPI:1407583685
Name:TAYLOR, ALISHA DAWN
Entity Type:Individual
Prefix:
First Name:ALISHA
Middle Name:DAWN
Last Name:TAYLOR
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 3178
Mailing Address - Street 2:
Mailing Address - City:CODY
Mailing Address - State:WY
Mailing Address - Zip Code:82414-5910
Mailing Address - Country:US
Mailing Address - Phone:360-460-9957
Mailing Address - Fax:
Practice Address - Street 1:1825 17TH ST
Practice Address - Street 2:
Practice Address - City:CODY
Practice Address - State:WY
Practice Address - Zip Code:82414-4701
Practice Address - Country:US
Practice Address - Phone:307-527-7426
Practice Address - Fax:307-527-7435
Is Sole Proprietor?:Yes
Enumeration Date:2022-08-06
Last Update Date:2022-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WY4399183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist