Healthcare Provider Details

I. General information

NPI: 1104381599
Provider Name (Legal Business Name): TAYLOR MICHELLE HEYEN RPH
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/10/2019
Last Update Date: 08/18/2023
Certification Date: 08/18/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1900 1ST CAPITOL DR
SAINT CHARLES MO
63301-1609
US

IV. Provider business mailing address

604 HILL LN
EDWARDSVILLE IL
62025-2016
US

V. Phone/Fax

Practice location:
  • Phone: 636-946-0738
  • Fax:
Mailing address:
  • Phone: 618-419-4738
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number2019003522
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: