Healthcare Provider Details

I. General information

NPI: 1700891330
Provider Name (Legal Business Name): TAYLOR HEALTH CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/30/2006
Last Update Date: 03/10/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

715 S FLORENCE
SPRINGFIELD MO
65897-0001
US

IV. Provider business mailing address

901 S NATIONAL AVE
SPRINGFIELD MO
65897-0027
US

V. Phone/Fax

Practice location:
  • Phone: 417-836-4050
  • Fax: 417-836-4086
Mailing address:
  • Phone: 417-836-4050
  • Fax: 417-836-4086

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number003141
License Number StateMO

VIII. Authorized Official

Name: RANDY BASS
Title or Position: PHARMACIST IN CHARGE
Credential: RPH
Phone: 417-836-4050