Provider Demographics
NPI:1780709857
Name:TAYLOR, ROGER A (PHARMD)
Entity type:Individual
Prefix:DR
First Name:ROGER
Middle Name:A
Last Name:TAYLOR
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2940 SUMMIT ST
Mailing Address - Street 2:SUITE 2F
Mailing Address - City:OAKLAND
Mailing Address - State:CA
Mailing Address - Zip Code:94609-3416
Mailing Address - Country:US
Mailing Address - Phone:510-628-0640
Mailing Address - Fax:510-291-9856
Practice Address - Street 1:2940 SUMMIT ST
Practice Address - Street 2:SUITE 2F
Practice Address - City:OAKLAND
Practice Address - State:CA
Practice Address - Zip Code:94609-3416
Practice Address - Country:US
Practice Address - Phone:510-628-0640
Practice Address - Fax:510-291-9856
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-20
Last Update Date:2009-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA40774183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist