Provider Demographics
NPI:1952022386
Name:MEALEY, TAYLOR ADELINE
Entity Type:Individual
Prefix:
First Name:TAYLOR
Middle Name:ADELINE
Last Name:MEALEY
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 1:1702 11TH ST
Mailing Address - Street 2:
Mailing Address - City:HUNTSVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:77340-3723
Mailing Address - Country:US
Mailing Address - Phone:936-291-0302
Mailing Address - Fax:866-319-9398
Practice Address - Street 1:1702 11TH ST
Practice Address - Street 2:
Practice Address - City:HUNTSVILLE
Practice Address - State:TX
Practice Address - Zip Code:77340-3723
Practice Address - Country:US
Practice Address - Phone:713-360-9938
Practice Address - Fax:866-319-9398
Is Sole Proprietor?:No
Enumeration Date:2022-09-05
Last Update Date:2022-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX300495183700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183700000XPharmacy Service ProvidersPharmacy Technician