MEDICARE: DR. TAYLOR HALLON DIWELGAMA PHARMD

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	PD15847	AR
2	183500000X	Pharmacist	22384	NV
3	183500000X	Pharmacist	13934686-1701	UT

General Provider Information

NPI Number	:	1821661778
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. TAYLOR HALLON DIWELGAMA PHARMD

Provider Business Mailing Address
First Line	:	3041 N RAINBOW BLVD
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89108-4586
Country	:	US
Telephone Number	:	602-656-7331
Fax Number	:	702-656-6732

Provider Business Practice Location Address
First Line	:	3041 N RAINBOW BLVD
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89108
Country	:	US
Telephone Number	:	702-656-7331
Fax Number	:	702-656-6732

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

Provider Enumeration Date	:	07/19/2021
Last Update Date	:	04/13/2026

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