Healthcare Provider Details

I. General information

NPI: 1558032052
Provider Name (Legal Business Name): TAYLOR MIZE PHARMD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/23/2021
Last Update Date: 09/23/2021
Certification Date: 08/03/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12220 S 71 HWY
GRANDVIEW MO
64030-1130
US

IV. Provider business mailing address

12220 S 71 HWY
GRANDVIEW MO
64030-1130
US

V. Phone/Fax

Practice location:
  • Phone: 816-777-2448
  • Fax: 816-777-2579
Mailing address:
  • Phone: 816-777-2448
  • Fax: 816-777-2579

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number2021029654
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: