Provider Demographics
NPI:1255931275
Name:TAYLOR, THAO NGUYEN
Entity type:Individual
Prefix:
First Name:THAO
Middle Name:NGUYEN
Last Name:TAYLOR
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:THAO
Other - Middle Name:XUAN
Other - Last Name:NGUYEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2910 VICTORIA CV
Mailing Address - Street 2:
Mailing Address - City:ROUND ROCK
Mailing Address - State:TX
Mailing Address - Zip Code:78664-6250
Mailing Address - Country:US
Mailing Address - Phone:512-705-1779
Mailing Address - Fax:
Practice Address - Street 1:709 W US HIGHWAY 79
Practice Address - Street 2:
Practice Address - City:ROCKDALE
Practice Address - State:TX
Practice Address - Zip Code:76567-5325
Practice Address - Country:US
Practice Address - Phone:512-446-3401
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-10-28
Last Update Date:2020-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX39031183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist