Healthcare Provider Details

I. General information

NPI: 1023854544
Provider Name (Legal Business Name): TAYLORS PHARMACY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/03/2024
Last Update Date: 07/03/2024
Certification Date: 07/03/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1021 W FAIRBANKS AVE
WINTER PARK FL
32789-4718
US

IV. Provider business mailing address

1021 W FAIRBANKS AVE
WINTER PARK FL
32789-4718
US

V. Phone/Fax

Practice location:
  • Phone: 407-644-1025
  • Fax: 407-539-2143
Mailing address:
  • Phone: 407-644-1025
  • Fax: 407-539-2143

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0004X
TaxonomyCompounding Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: MICHAEL WILLIAM JOHNSON
Title or Position: GENERAL MANAGER/PHARMACIST
Credential: R.PH
Phone: 407-644-1025