Provider Demographics
NPI:1598217275
Name:TAYLOR BROTHERS PHARMACY LLC
Entity Type:Organization
Organization Name:TAYLOR BROTHERS PHARMACY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:KELLEY
Authorized Official - Last Name:OWEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:731-264-5651
Mailing Address - Street 1:109 N MAIN ST
Mailing Address - Street 2:
Mailing Address - City:RIDGELY
Mailing Address - State:TN
Mailing Address - Zip Code:38080-1316
Mailing Address - Country:US
Mailing Address - Phone:731-264-5651
Mailing Address - Fax:731-264-5356
Practice Address - Street 1:650 CARL PERKINS PARKWAY
Practice Address - Street 2:
Practice Address - City:TIPTONVILLE
Practice Address - State:TN
Practice Address - Zip Code:38079-1678
Practice Address - Country:US
Practice Address - Phone:731-264-5651
Practice Address - Fax:731-264-5356
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-10-28
Last Update Date:2016-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN9449354Medicaid