Healthcare Provider Details

I. General information

NPI: 1740029016
Provider Name (Legal Business Name): TAYLOR KLUESNER PHARMD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/24/2024
Last Update Date: 05/24/2024
Certification Date: 05/24/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

720 S 6TH ST
MONTICELLO IN
47960-8182
US

IV. Provider business mailing address

4123 CALDER DR
LAFAYETTE IN
47909-6256
US

V. Phone/Fax

Practice location:
  • Phone: 574-583-7111
  • Fax:
Mailing address:
  • Phone: 317-498-6505
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1835P2201X
TaxonomyAmbulatory Care Pharmacist
License Number26029461A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: