Provider Demographics
NPI:1629335302
Name:TAYLOR, KIMBERLY SUZANNE (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:KIMBERLY
Middle Name:SUZANNE
Last Name:TAYLOR
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1319 BROADMOOR ST
Mailing Address - Street 2:
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38111-7310
Mailing Address - Country:US
Mailing Address - Phone:731-693-4649
Mailing Address - Fax:
Practice Address - Street 1:1936 W POPLAR AVE
Practice Address - Street 2:
Practice Address - City:COLLIERVILLE
Practice Address - State:TN
Practice Address - Zip Code:38017-0605
Practice Address - Country:US
Practice Address - Phone:901-853-6012
Practice Address - Fax:901-854-7630
Is Sole Proprietor?:No
Enumeration Date:2012-04-18
Last Update Date:2012-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN35994183500000X
MSE-11703183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist