Healthcare Provider Details

I. General information

NPI: 1255453536
Provider Name (Legal Business Name): ROBERT MICHAEL TAYLOR
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/06/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5600 FISHERS LN PARKLAWN BUILDING, ROOM 6C26
ROCKVILLE MD
20857-0001
US

IV. Provider business mailing address

402 CANO CT
FORT WASHINGTON MD
20744-5165
US

V. Phone/Fax

Practice location:
  • Phone: 301-443-0569
  • Fax:
Mailing address:
  • Phone: 301-292-8671
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number09184
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: