Provider Demographics
NPI:1912665068
Name:TAYLOR, JUSTIN SAUL (PHARM D)
Entity Type:Individual
Prefix:
First Name:JUSTIN
Middle Name:SAUL
Last Name:TAYLOR
Suffix:
Gender:M
Credentials:PHARM D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7415 COLONIAL DR
Mailing Address - Street 2:
Mailing Address - City:NIAGARA FALLS
Mailing Address - State:NY
Mailing Address - Zip Code:14305-1463
Mailing Address - Country:US
Mailing Address - Phone:716-628-9002
Mailing Address - Fax:
Practice Address - Street 1:1030 PINE AVE
Practice Address - Street 2:
Practice Address - City:NIAGARA FALLS
Practice Address - State:NY
Practice Address - Zip Code:14301-1810
Practice Address - Country:US
Practice Address - Phone:716-285-0514
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-12-06
Last Update Date:2021-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY066308183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist