Healthcare Provider Details

I. General information

NPI: 1063196525
Provider Name (Legal Business Name): TAYLOR ADCOCK
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/14/2023
Last Update Date: 06/14/2023
Certification Date: 06/13/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3975 I 55 N APT G2
JACKSON MS
39216-3710
US

IV. Provider business mailing address

3975 I 55 N APT G2
JACKSON MS
39216-3710
US

V. Phone/Fax

Practice location:
  • Phone: 662-582-2857
  • Fax:
Mailing address:
  • Phone: 662-582-2857
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1835P2201X
TaxonomyAmbulatory Care Pharmacist
License NumberE-100288
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: