Provider Demographics
NPI:1023649290
Name:TAYLOR, LAURA S (CPHT)
Entity type:Individual
Prefix:
First Name:LAURA
Middle Name:S
Last Name:TAYLOR
Suffix:
Gender:F
Credentials:CPHT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:211 COMMERCE DR
Mailing Address - Street 2:
Mailing Address - City:MEDINA
Mailing Address - State:OH
Mailing Address - Zip Code:44256-1331
Mailing Address - Country:US
Mailing Address - Phone:330-725-2340
Mailing Address - Fax:330-764-4857
Practice Address - Street 1:211 COMMERCE DR
Practice Address - Street 2:
Practice Address - City:MEDINA
Practice Address - State:OH
Practice Address - Zip Code:44256-1331
Practice Address - Country:US
Practice Address - Phone:330-725-2340
Practice Address - Fax:330-764-4857
Is Sole Proprietor?:No
Enumeration Date:2020-01-28
Last Update Date:2020-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH09300154183700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183700000XPharmacy Service ProvidersPharmacy Technician