Provider Demographics
NPI:1770217697
Name:TAYLOR, MARISSA PEARL (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:MARISSA
Middle Name:PEARL
Last Name:TAYLOR
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1410 KASOLD DR STE A16
Mailing Address - Street 2:
Mailing Address - City:LAWRENCE
Mailing Address - State:KS
Mailing Address - Zip Code:66049-3428
Mailing Address - Country:US
Mailing Address - Phone:785-843-8555
Mailing Address - Fax:785-843-0645
Practice Address - Street 1:1410 KASOLD DR STE A16
Practice Address - Street 2:
Practice Address - City:LAWRENCE
Practice Address - State:KS
Practice Address - Zip Code:66049-3428
Practice Address - Country:US
Practice Address - Phone:785-843-8555
Practice Address - Fax:785-843-0645
Is Sole Proprietor?:No
Enumeration Date:2022-07-15
Last Update Date:2022-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS1-16279183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist