Provider Demographics
NPI:1982337176
Name:TAYLOR, COLTON NOAH (PHARMACIST)
Entity Type:Individual
Prefix:
First Name:COLTON
Middle Name:NOAH
Last Name:TAYLOR
Suffix:
Gender:M
Credentials:PHARMACIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11070 HIGHWAY 371 S
Mailing Address - Street 2:
Mailing Address - City:STAMPS
Mailing Address - State:AR
Mailing Address - Zip Code:71860-9635
Mailing Address - Country:US
Mailing Address - Phone:870-904-6241
Mailing Address - Fax:
Practice Address - Street 1:1600 DR MARTIN LUTHER KING JR DR
Practice Address - Street 2:
Practice Address - City:CROSSETT
Practice Address - State:AR
Practice Address - Zip Code:71635-3363
Practice Address - Country:US
Practice Address - Phone:870-634-8220
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-07-05
Last Update Date:2022-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARPD16069183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist