Provider Demographics
NPI:1932331733
Name:TAYLOR, JEREMIAH EZEKIEL (PHARMD)
Entity Type:Individual
Prefix:
First Name:JEREMIAH
Middle Name:EZEKIEL
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 1:525 N STATE OF FRANKLIN RD
Mailing Address - Street 2:
Mailing Address - City:JOHNSON CITY
Mailing Address - State:TN
Mailing Address - Zip Code:37604-8213
Mailing Address - Country:US
Mailing Address - Phone:423-926-6154
Mailing Address - Fax:
Practice Address - Street 1:525 N STATE OF FRANKLIN RD
Practice Address - Street 2:
Practice Address - City:JOHNSON CITY
Practice Address - State:TN
Practice Address - Zip Code:37604-8213
Practice Address - Country:US
Practice Address - Phone:423-926-6154
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-08-13
Last Update Date:2009-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN33579183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist