Provider Demographics
NPI:1831563121
Name:TAYLOR, TRACY
Entity type:Individual
Prefix:
First Name:TRACY
Middle Name:
Last Name:TAYLOR
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:PO BOX 26
Mailing Address - Street 2:
Mailing Address - City:ISLAND POND
Mailing Address - State:VT
Mailing Address - Zip Code:05846-0026
Mailing Address - Country:US
Mailing Address - Phone:802-723-1031
Mailing Address - Fax:
Practice Address - Street 1:12 RAILROAD ST
Practice Address - Street 2:
Practice Address - City:ISLAND POND
Practice Address - State:VT
Practice Address - Zip Code:05846-0026
Practice Address - Country:US
Practice Address - Phone:802-723-1031
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-11-24
Last Update Date:2015-11-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT121-0000446183700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183700000XPharmacy Service ProvidersPharmacy Technician