Provider Demographics
NPI:1609148196
Name:TAYLOR, STACY LYNN (RPH)
Entity Type:Individual
Prefix:
First Name:STACY
Middle Name:LYNN
Last Name:TAYLOR
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:501 ROOSEVELT BOULEVARD
Mailing Address - Street 2:
Mailing Address - City:ELEANOR
Mailing Address - State:WV
Mailing Address - Zip Code:25070
Mailing Address - Country:US
Mailing Address - Phone:304-586-0886
Mailing Address - Fax:304-586-1057
Practice Address - Street 1:4016 OHIO RIVER RD
Practice Address - Street 2:
Practice Address - City:POINT PLEASANT
Practice Address - State:WV
Practice Address - Zip Code:25550
Practice Address - Country:US
Practice Address - Phone:304-586-0886
Practice Address - Fax:304-586-1057
Is Sole Proprietor?:Yes
Enumeration Date:2012-01-31
Last Update Date:2012-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WVRP0005921183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist