Healthcare Provider Details

I. General information

NPI: 1063630176
Provider Name (Legal Business Name): SCOTT M TAYLOR PHARM.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/23/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

929 N SAINT FRANCIS ST VIA CHRISTI REGIONAL MEDICAL CENTER DEPT OF PHARMACY
WICHITA KS
67214-3821
US

IV. Provider business mailing address

15808 W MCCORMICK AVE
GODDARD KS
67052-5213
US

V. Phone/Fax

Practice location:
  • Phone: 316-268-5702
  • Fax: 316-291-7443
Mailing address:
  • Phone: 316-722-8097
  • Fax: 316-722-8097

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1835P1200X
TaxonomyPharmacotherapy Pharmacist
License Number13512
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: