Provider Demographics
NPI:1629295084
Name:TAYLOR, MICHAEL BRUCE
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:BRUCE
Last Name:TAYLOR
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:309 LICKSKILLET RD
Mailing Address - Street 2:
Mailing Address - City:OLMSTEAD
Mailing Address - State:KY
Mailing Address - Zip Code:42265-9117
Mailing Address - Country:US
Mailing Address - Phone:270-726-7308
Mailing Address - Fax:
Practice Address - Street 1:1625 NASHVILLE ST
Practice Address - Street 2:
Practice Address - City:RUSSELLVILLE
Practice Address - State:KY
Practice Address - Zip Code:42276-8853
Practice Address - Country:US
Practice Address - Phone:270-725-4528
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY011017183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist