Provider Demographics
NPI:1396807343
Name:TAYLOR, WILSON LEE (RPH)
Entity type:Individual
Prefix:
First Name:WILSON
Middle Name:LEE
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:PO BOX 1023
Mailing Address - Street 2:
Mailing Address - City:VAN ALSTYNE
Mailing Address - State:TX
Mailing Address - Zip Code:75495-1023
Mailing Address - Country:US
Mailing Address - Phone:903-482-5341
Mailing Address - Fax:
Practice Address - Street 1:133 MCKINNEY ST
Practice Address - Street 2:
Practice Address - City:FARMERSVILLE
Practice Address - State:TX
Practice Address - Zip Code:75442-2221
Practice Address - Country:US
Practice Address - Phone:972-782-6262
Practice Address - Fax:972-782-7870
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX25655183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist