Provider Demographics
NPI:1124176607
Name:TAYLOR, HAROLD JACK (RPH)
Entity type:Individual
Prefix:MR
First Name:HAROLD
Middle Name:JACK
Last Name:TAYLOR
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8204 CARIBOU TRL APT 1D
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43235-4464
Mailing Address - Country:US
Mailing Address - Phone:614-431-0388
Mailing Address - Fax:
Practice Address - Street 1:1493 PARSONS AVE
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43207-1230
Practice Address - Country:US
Practice Address - Phone:614-444-5992
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH03-2-10042183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist