Provider Demographics
NPI:1720608649
Name:FOSUHENE, TAYLOR A
Entity Type:Individual
Prefix:
First Name:TAYLOR
Middle Name:A
Last Name:FOSUHENE
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 1:6904 BARRY RD
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33634-2916
Mailing Address - Country:US
Mailing Address - Phone:904-316-4012
Mailing Address - Fax:
Practice Address - Street 1:9202 N FLORIDA AVE
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33612-7906
Practice Address - Country:US
Practice Address - Phone:813-935-1134
Practice Address - Fax:813-930-6914
Is Sole Proprietor?:No
Enumeration Date:2020-04-21
Last Update Date:2021-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRPT64370183700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183700000XPharmacy Service ProvidersPharmacy Technician