Healthcare Provider Details

I. General information

NPI: 1174470124
Provider Name (Legal Business Name): TAYLOR TRAN PHARMD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/10/2026
Last Update Date: 06/19/2026
Certification Date: 06/19/2026
Deactivation Date: 04/03/2026
Reactivation Date: 06/19/2026

III. Provider practice location address

1478 W GRANADA BLVD
ORMOND BEACH FL
32174-9165
US

IV. Provider business mailing address

1478 W GRANADA BLVD
ORMOND BEACH FL
32174-9165
US

V. Phone/Fax

Practice location:
  • Phone: 386-677-4215
  • Fax:
Mailing address:
  • Phone: 386-677-4215
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberPS69856
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: