Provider Demographics
NPI:1689369084
Name:KOUTZ, TAYLOR RAY (TCH)
Entity Type:Individual
Prefix:
First Name:TAYLOR
Middle Name:RAY
Last Name:KOUTZ
Suffix:
Gender:F
Credentials:TCH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2477 BALDWIN AVE
Mailing Address - Street 2:
Mailing Address - City:OROVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:95966-5101
Mailing Address - Country:US
Mailing Address - Phone:530-282-8198
Mailing Address - Fax:
Practice Address - Street 1:2700 ORO DAM BLVD E
Practice Address - Street 2:
Practice Address - City:OROVILLE
Practice Address - State:CA
Practice Address - Zip Code:95966-5117
Practice Address - Country:US
Practice Address - Phone:530-533-8083
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-04-10
Last Update Date:2023-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183700000XPharmacy Service ProvidersPharmacy Technician