Provider Demographics
NPI:1982011524
Name:TAYLOR, RANDI
Entity Type:Individual
Prefix:
First Name:RANDI
Middle Name:
Last Name:TAYLOR
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 1:130 SARBER LN
Mailing Address - Street 2:
Mailing Address - City:MANHATTAN
Mailing Address - State:KS
Mailing Address - Zip Code:66502-5002
Mailing Address - Country:US
Mailing Address - Phone:785-776-0060
Mailing Address - Fax:785-587-1725
Practice Address - Street 1:130 SARBER LN
Practice Address - Street 2:
Practice Address - City:MANHATTAN
Practice Address - State:KS
Practice Address - Zip Code:66502-5002
Practice Address - Country:US
Practice Address - Phone:785-776-0060
Practice Address - Fax:785-587-1725
Is Sole Proprietor?:No
Enumeration Date:2014-07-15
Last Update Date:2014-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS1-14947183500000X
NE13443183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist