Healthcare Provider Details

I. General information

NPI: 1063988236
Provider Name (Legal Business Name): ARNOLD RICARDO TAYLOR PHARMD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/15/2018
Last Update Date: 08/21/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6853 DOUGLAS BLVD STE A
DOUGLASVILLE GA
30135-7178
US

IV. Provider business mailing address

7421 DOUGLAS BLVD STE N415
DOUGLASVILLE GA
30135-1564
US

V. Phone/Fax

Practice location:
  • Phone: 770-942-1044
  • Fax: 770-942-1699
Mailing address:
  • Phone: 770-942-1044
  • Fax: 770-942-1699

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberRPH021316
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: