Healthcare Provider Details

I. General information

NPI: 1760049605
Provider Name (Legal Business Name): TAYLOR MUGHMAW PHARMD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/28/2019
Last Update Date: 05/28/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1701 N SENATE BLVD
INDIANAPOLIS IN
46202-1239
US

IV. Provider business mailing address

3918 ALEX CT
LAFAYETTE IN
47905-7746
US

V. Phone/Fax

Practice location:
  • Phone: 765-714-3824
  • Fax:
Mailing address:
  • Phone: 765-714-3824
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1835P2201X
TaxonomyAmbulatory Care Pharmacist
License Number26027729A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: