Healthcare Provider Details

I. General information

NPI: 1548419013
Provider Name (Legal Business Name): PAUL G. TAYLOR R.PH., CFTS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/09/2008
Last Update Date: 05/13/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6360 E NC 150 HWY TAYLOR MED PHARMACY/GENERAL STORE
SHERRILLS FORD NC
28673-9404
US

IV. Provider business mailing address

114 SURFSIDE LN
MOORESVILLE NC
28117-7464
US

V. Phone/Fax

Practice location:
  • Phone: 704-483-9150
  • Fax: 704-664-1999
Mailing address:
  • Phone: 704-664-1999
  • Fax: 704-664-1999

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number09264
License Number StateNC
# 2
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License NumberCFTS0708
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: