Provider Demographics
NPI:1821608415
Name:DOUGLAS, TAYLOR (PHARMD)
Entity Type:Individual
Prefix:
First Name:TAYLOR
Middle Name:
Last Name:DOUGLAS
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 1:470 GARRAD RD
Mailing Address - Street 2:
Mailing Address - City:TOLLESBORO
Mailing Address - State:KY
Mailing Address - Zip Code:41189-8653
Mailing Address - Country:US
Mailing Address - Phone:606-782-6800
Mailing Address - Fax:
Practice Address - Street 1:470 GARRAD RD
Practice Address - Street 2:
Practice Address - City:TOLLESBORO
Practice Address - State:KY
Practice Address - Zip Code:41189-8653
Practice Address - Country:US
Practice Address - Phone:606-782-6800
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-08-07
Last Update Date:2020-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH034399361835P0018X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P0018XPharmacy Service ProvidersPharmacistPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist