Provider Demographics
NPI:1497031744
Name:TAYLOR, ALICIA L (PHARMD)
Entity Type:Individual
Prefix:
First Name:ALICIA
Middle Name:L
Last Name:TAYLOR
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:ALICIA
Other - Middle Name:L
Other - Last Name:SHELTON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PHARMD
Mailing Address - Street 1:180 JACKSON ST NE APT 5210
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30312-7935
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:4470 CHAMBLEE DUNWOODY RD
Practice Address - Street 2:
Practice Address - City:DUNWOODY
Practice Address - State:GA
Practice Address - Zip Code:30338-6280
Practice Address - Country:US
Practice Address - Phone:470-282-3126
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-11-01
Last Update Date:2020-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARPH021353183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist