Provider Demographics
NPI:1467009050
Name:CLEMONS, TAYLOR (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:TAYLOR
Middle Name:
Last Name:CLEMONS
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8248 LITTLE SYDNEYS WAY
Mailing Address - Street 2:
Mailing Address - City:CHARLESTON
Mailing Address - State:SC
Mailing Address - Zip Code:29406-8923
Mailing Address - Country:US
Mailing Address - Phone:484-686-4998
Mailing Address - Fax:
Practice Address - Street 1:25 COURTENAY DRIVE
Practice Address - Street 2:
Practice Address - City:CHARLESTONS
Practice Address - State:SC
Practice Address - Zip Code:29425-8911
Practice Address - Country:US
Practice Address - Phone:843-792-5691
Practice Address - Fax:843-876-4583
Is Sole Proprietor?:No
Enumeration Date:2019-08-20
Last Update Date:2019-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC42155183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist