Provider Demographics
NPI:1821308057
Name:TAYLOR, THOMAS (PHARMD)
Entity Type:Individual
Prefix:
First Name:THOMAS
Middle Name:
Last Name:TAYLOR
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:207 S 2ND ST
Mailing Address - Street 2:
Mailing Address - City:CABOT
Mailing Address - State:AR
Mailing Address - Zip Code:72023-2919
Mailing Address - Country:US
Mailing Address - Phone:501-843-5814
Mailing Address - Fax:501-605-0389
Practice Address - Street 1:207 S 2ND ST
Practice Address - Street 2:
Practice Address - City:CABOT
Practice Address - State:AR
Practice Address - Zip Code:72023-2919
Practice Address - Country:US
Practice Address - Phone:501-843-5814
Practice Address - Fax:501-605-0389
Is Sole Proprietor?:Yes
Enumeration Date:2010-10-21
Last Update Date:2010-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARPD08719183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist