Provider Demographics
NPI:1831579119
Name:TAYLOR, ERNEST RANDALL (PHARMD)
Entity type:Individual
Prefix:DR
First Name:ERNEST
Middle Name:RANDALL
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 1:3521 CORUNNA RD
Mailing Address - Street 2:
Mailing Address - City:FLINT
Mailing Address - State:MI
Mailing Address - Zip Code:48503-3267
Mailing Address - Country:US
Mailing Address - Phone:810-235-6363
Mailing Address - Fax:810-424-3260
Practice Address - Street 1:3521 CORUNNA RD
Practice Address - Street 2:
Practice Address - City:FLINT
Practice Address - State:MI
Practice Address - Zip Code:48503-3267
Practice Address - Country:US
Practice Address - Phone:810-235-6363
Practice Address - Fax:810-424-3260
Is Sole Proprietor?:No
Enumeration Date:2015-06-02
Last Update Date:2015-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5302031788183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist