Provider Demographics
NPI:1134859119
Name:TAYLOR, RENEE MICHELE
Entity type:Individual
Prefix:DR
First Name:RENEE
Middle Name:MICHELE
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 1:4581 CHARING CROSS ST
Mailing Address - Street 2:
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38116-2009
Mailing Address - Country:US
Mailing Address - Phone:727-647-7592
Mailing Address - Fax:
Practice Address - Street 1:2945 GOODMAN RD E
Practice Address - Street 2:
Practice Address - City:SOUTHAVEN
Practice Address - State:MS
Practice Address - Zip Code:38672-9073
Practice Address - Country:US
Practice Address - Phone:662-772-5859
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-06-13
Last Update Date:2022-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN35395183500000X
MST-12997183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist