Healthcare Provider Details

I. General information

NPI: 1386281145
Provider Name (Legal Business Name): CHARLOTTE TAYLOR PHARMD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: CHARLOTTE WESLEY PHARMD

II. Dates (important events)

Enumeration Date: 11/28/2019
Last Update Date: 05/20/2026
Certification Date: 05/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1729 W BROADWAY
COLUMBIA MO
65203-1190
US

IV. Provider business mailing address

1729 W BROADWAY
COLUMBIA MO
65203-1190
US

V. Phone/Fax

Practice location:
  • Phone: 573-445-9451
  • Fax:
Mailing address:
  • Phone: 573-445-9451
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1835P0018X
TaxonomyPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
License Number5302045833
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: