Provider Demographics
NPI:1760009732
Name:BRYCHELL, TAYLOR EILEEN (PHARMD)
Entity Type:Individual
Prefix:
First Name:TAYLOR
Middle Name:EILEEN
Last Name:BRYCHELL
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 1:576 E LONG LAKE RD
Mailing Address - Street 2:
Mailing Address - City:VALPARAISO
Mailing Address - State:IN
Mailing Address - Zip Code:46383-1663
Mailing Address - Country:US
Mailing Address - Phone:219-241-8826
Mailing Address - Fax:
Practice Address - Street 1:1903 CALUMET AVE
Practice Address - Street 2:
Practice Address - City:VALPARAISO
Practice Address - State:IN
Practice Address - Zip Code:46383-2703
Practice Address - Country:US
Practice Address - Phone:219-462-6172
Practice Address - Fax:219-465-6890
Is Sole Proprietor?:No
Enumeration Date:2020-06-25
Last Update Date:2020-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN26027823A183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist