Provider Demographics
NPI:1477039071
Name:KELLAM, TAYLOR (PHARMD)
Entity Type:Individual
Prefix:
First Name:TAYLOR
Middle Name:
Last Name:KELLAM
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 1:1817 N WAHSATCH AVE
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80907-7603
Mailing Address - Country:US
Mailing Address - Phone:307-631-3957
Mailing Address - Fax:
Practice Address - Street 1:6925 MESA RIDGE PKWY
Practice Address - Street 2:
Practice Address - City:FOUNTAIN
Practice Address - State:CO
Practice Address - Zip Code:80817-1504
Practice Address - Country:US
Practice Address - Phone:719-322-9357
Practice Address - Fax:719-322-9367
Is Sole Proprietor?:Yes
Enumeration Date:2018-07-17
Last Update Date:2018-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO22020333600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy