Provider Demographics
NPI:1790152957
Name:TAYLOR, MARK (RPH)
Entity Type:Individual
Prefix:
First Name:MARK
Middle Name:
Last Name:TAYLOR
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3007 OCEAN HEIGHTS AVE
Mailing Address - Street 2:CUREXA
Mailing Address - City:EGG HARBOR TOWNSHIP
Mailing Address - State:NJ
Mailing Address - Zip Code:08234-7749
Mailing Address - Country:US
Mailing Address - Phone:609-892-0301
Mailing Address - Fax:609-927-0392
Practice Address - Street 1:3007 OCEAN HEIGHTS AVE
Practice Address - Street 2:CUREXA
Practice Address - City:EGG HARBOR TOWNSHIP
Practice Address - State:NJ
Practice Address - Zip Code:08234-7749
Practice Address - Country:US
Practice Address - Phone:609-892-0301
Practice Address - Fax:609-927-0392
Is Sole Proprietor?:Yes
Enumeration Date:2015-08-24
Last Update Date:2015-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ28RI02157700183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist