Provider Demographics
NPI:1255453536
Name:TAYLOR, ROBERT MICHAEL
Entity type:Individual
Prefix:
First Name:ROBERT
Middle Name:MICHAEL
Last Name:TAYLOR
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:402 CANO CT
Mailing Address - Street 2:
Mailing Address - City:FORT WASHINGTON
Mailing Address - State:MD
Mailing Address - Zip Code:20744-5165
Mailing Address - Country:US
Mailing Address - Phone:301-292-8671
Mailing Address - Fax:
Practice Address - Street 1:5600 FISHERS LN
Practice Address - Street 2:PARKLAWN BUILDING, ROOM 6C26
Practice Address - City:ROCKVILLE
Practice Address - State:MD
Practice Address - Zip Code:20857-0001
Practice Address - Country:US
Practice Address - Phone:301-443-0569
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-04-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD09184183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist