Provider Demographics
NPI:1740014786
Name:NOLAND, TAYLOR D
Entity type:Individual
Prefix:
First Name:TAYLOR
Middle Name:D
Last Name:NOLAND
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 1:11905 PERRY ST
Mailing Address - Street 2:
Mailing Address - City:WESTMINSTER
Mailing Address - State:CO
Mailing Address - Zip Code:80031-5005
Mailing Address - Country:US
Mailing Address - Phone:307-439-3168
Mailing Address - Fax:
Practice Address - Street 1:1601 COALTON RD
Practice Address - Street 2:
Practice Address - City:SUPERIOR
Practice Address - State:CO
Practice Address - Zip Code:80027-4610
Practice Address - Country:US
Practice Address - Phone:303-543-2314
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-08-30
Last Update Date:2024-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COPHA-0024931183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist