Healthcare Provider Details

I. General information

NPI: 1356945679
Provider Name (Legal Business Name): TAYLOR HAMS PHARMD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/27/2020
Last Update Date: 11/04/2022
Certification Date: 11/04/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3557 STARDUST DR
HANNIBAL MO
63401-6224
US

IV. Provider business mailing address

3557 STARDUST DR
HANNIBAL MO
63401-6224
US

V. Phone/Fax

Practice location:
  • Phone: 573-603-1460
  • Fax:
Mailing address:
  • Phone: 573-603-1460
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code183500000X
TaxonomyPharmacist
License Number2014010786
License Number StateMO
# 2
Primary TaxonomyY
Taxonomy Code1835P1200X
TaxonomyPharmacotherapy Pharmacist
License Number2014010786
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: