Provider Demographics
NPI:1740766120
Name:TAYLOR, MARIAH LEIGH
Entity Type:Individual
Prefix:
First Name:MARIAH
Middle Name:LEIGH
Last Name:TAYLOR
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15505 378TH AVE
Mailing Address - Street 2:
Mailing Address - City:NORTHVILLE
Mailing Address - State:SD
Mailing Address - Zip Code:57465-5015
Mailing Address - Country:US
Mailing Address - Phone:605-290-2976
Mailing Address - Fax:
Practice Address - Street 1:3820 7TH AVE SE
Practice Address - Street 2:
Practice Address - City:ABERDEEN
Practice Address - State:SD
Practice Address - Zip Code:57401-6638
Practice Address - Country:US
Practice Address - Phone:605-229-1519
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-07-18
Last Update Date:2018-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SD6603183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist