Provider Demographics
NPI:1578661203
Name:TAYLOR, LORI NESTOR
Entity Type:Individual
Prefix:
First Name:LORI
Middle Name:NESTOR
Last Name:TAYLOR
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:LORI
Other - Middle Name:MARIE
Other - Last Name:NESTOR
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:8324 N ROCKY BROOK DR
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85743-1477
Mailing Address - Country:US
Mailing Address - Phone:520-990-5675
Mailing Address - Fax:
Practice Address - Street 1:6370 N CAMPBELL AVE
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85718-3174
Practice Address - Country:US
Practice Address - Phone:520-299-7390
Practice Address - Fax:520-299-7396
Is Sole Proprietor?:No
Enumeration Date:2006-09-20
Last Update Date:2013-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ11285183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist