Provider Demographics
NPI:1912627597
Name:TAYLOR, BRANDON LEE (PHARMD)
Entity Type:Individual
Prefix:
First Name:BRANDON
Middle Name:LEE
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 1:16210 S 88TH EAST AVE
Mailing Address - Street 2:
Mailing Address - City:BIXBY
Mailing Address - State:OK
Mailing Address - Zip Code:74008-3265
Mailing Address - Country:US
Mailing Address - Phone:918-408-5189
Mailing Address - Fax:
Practice Address - Street 1:12200 S WACO AVE
Practice Address - Street 2:
Practice Address - City:GLENPOOL
Practice Address - State:OK
Practice Address - Zip Code:74033-5655
Practice Address - Country:US
Practice Address - Phone:918-299-8052
Practice Address - Fax:918-299-8055
Is Sole Proprietor?:No
Enumeration Date:2022-09-01
Last Update Date:2022-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK19808183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK19808OtherOK PHARMACY LICENSE