Provider Demographics
NPI:1871002741
Name:ROOD, TAYLOR
Entity Type:Individual
Prefix:
First Name:TAYLOR
Middle Name:
Last Name:ROOD
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5229 OLD ONEIDA RD APT 4
Mailing Address - Street 2:
Mailing Address - City:VERONA
Mailing Address - State:NY
Mailing Address - Zip Code:13478-2128
Mailing Address - Country:US
Mailing Address - Phone:315-225-4450
Mailing Address - Fax:
Practice Address - Street 1:6430 KIRKVILLE RD STE 5
Practice Address - Street 2:
Practice Address - City:EAST SYRACUSE
Practice Address - State:NY
Practice Address - Zip Code:13057
Practice Address - Country:US
Practice Address - Phone:315-437-7305
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-09-23
Last Update Date:2019-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYI063477183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist