Provider Demographics
NPI:1457679060
Name:TAYLOR, ROBERT E (PHARMACIST)
Entity Type:Individual
Prefix:MR
First Name:ROBERT
Middle Name:E
Last Name:TAYLOR
Suffix:
Gender:M
Credentials:PHARMACIST
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 742
Mailing Address - Street 2:
Mailing Address - City:HONAKER
Mailing Address - State:VA
Mailing Address - Zip Code:24260-0742
Mailing Address - Country:US
Mailing Address - Phone:276-873-6132
Mailing Address - Fax:276-873-4614
Practice Address - Street 1:5300 REDBUD HWY
Practice Address - Street 2:
Practice Address - City:HONAKER
Practice Address - State:VA
Practice Address - Zip Code:24260
Practice Address - Country:US
Practice Address - Phone:276-873-6132
Practice Address - Fax:276-873-4614
Is Sole Proprietor?:No
Enumeration Date:2010-05-06
Last Update Date:2010-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0202004501183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA008513431Medicaid
VA008513431Medicaid