MEDICARE: TAILOR MADE SEAMOSS LTD

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	3336C0003X	Community/Retail Pharmacy
2	261Q00000X	Clinic/Center

General Provider Information

NPI Number	:	1851100291
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	TAILOR MADE SEAMOSS LTD

Provider Business Mailing Address
First Line	:	635 BROADWAY AVE
Second Line	:
City	:	BEDFORD
State	:	OH
Zip	:	44146-3504
Country	:	US
Telephone Number	:	216-889-7832
Fax Number	:

Provider Business Practice Location Address
First Line	:	635 BROADWAY AVE
Second Line	:
City	:	BEDFORD
State	:	OH
Zip	:	44146-3504
Country	:	US
Telephone Number	:	216-889-7832
Fax Number	:

Authorized Official
Title or Position	:	CEO
Name	:	MRS. DEAIRRA D TAYLOR
Credential	:
Telephone Number	:	216-527-3630

Provider Enumeration Date	:	12/31/2024
Last Update Date	:	01/13/2025

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