Provider Demographics
NPI:1609463124
Name:TAYLOR, PHILLIP (RPH)
Entity Type:Individual
Prefix:
First Name:PHILLIP
Middle Name:
Last Name:TAYLOR
Suffix:
Gender:M
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:PO BOX 4460
Mailing Address - Street 2:
Mailing Address - City:CANTON
Mailing Address - State:GA
Mailing Address - Zip Code:30114-0200
Mailing Address - Country:US
Mailing Address - Phone:770-479-2171
Mailing Address - Fax:
Practice Address - Street 1:6824 REINHARDT COLLEGE PKWY
Practice Address - Street 2:
Practice Address - City:WALESKA
Practice Address - State:GA
Practice Address - Zip Code:30183-3266
Practice Address - Country:US
Practice Address - Phone:770-479-2172
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-12-30
Last Update Date:2020-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARPH013361183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist