MEDICARE: DR. TAYLOR MICHELLE HEYEN RPH

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	183500000X	Pharmacist	2019003522	MO

General Provider Information

NPI Number	:	1104381599
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. TAYLOR MICHELLE HEYEN RPH

Provider Business Mailing Address
First Line	:	604 HILL LN
Second Line	:
City	:	EDWARDSVILLE
State	:	IL
Zip	:	62025-2016
Country	:	US
Telephone Number	:	618-419-4738
Fax Number	:

Provider Business Practice Location Address
First Line	:	1900 1ST CAPITOL DR
Second Line	:
City	:	SAINT CHARLES
State	:	MO
Zip	:	63301-1609
Country	:	US
Telephone Number	:	636-946-0738
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/10/2019
Last Update Date	:	08/18/2023

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