Provider Demographics
NPI:1811469182
Name:BIRD, TAYLOR JAMES
Entity type:Individual
Prefix:
First Name:TAYLOR
Middle Name:JAMES
Last Name:BIRD
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:25 FRANKLIN ST APT F
Mailing Address - Street 2:
Mailing Address - City:EASTHAMPTON
Mailing Address - State:MA
Mailing Address - Zip Code:01027-1733
Mailing Address - Country:US
Mailing Address - Phone:413-212-1500
Mailing Address - Fax:
Practice Address - Street 1:476 CANAL ST
Practice Address - Street 2:
Practice Address - City:BRATTLEBORO
Practice Address - State:VT
Practice Address - Zip Code:05301-6621
Practice Address - Country:US
Practice Address - Phone:802-254-5633
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-12-26
Last Update Date:2018-12-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MAPH238575183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
VT033.0134224OtherSTATE OF VERMONT
MAPH238575OtherBOARD OF REGISTRATION IN PHARMACY