Provider Demographics
NPI:1598371460
Name:TAYLOR, BLAKE (PHARMD)
Entity Type:Individual
Prefix:
First Name:BLAKE
Middle Name:
Last Name:TAYLOR
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:206 TYLER AUSTIN RD
Mailing Address - Street 2:
Mailing Address - City:MARTIN
Mailing Address - State:TN
Mailing Address - Zip Code:38237-3844
Mailing Address - Country:US
Mailing Address - Phone:731-819-4281
Mailing Address - Fax:
Practice Address - Street 1:134 COURTRIGHT RD
Practice Address - Street 2:
Practice Address - City:MARTIN
Practice Address - State:TN
Practice Address - Zip Code:38237-1606
Practice Address - Country:US
Practice Address - Phone:731-587-3819
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-09-16
Last Update Date:2020-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN44074183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist