Healthcare Provider Details

I. General information

NPI: 1598681678
Provider Name (Legal Business Name): TAYLOR MENNOR
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/24/2026
Last Update Date: 06/24/2026
Certification Date: 06/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

131 PINE RIDGE DR
CHICORA PA
16025-4307
US

IV. Provider business mailing address

131 PINE RIDGE DR
CHICORA PA
16025-4307
US

V. Phone/Fax

Practice location:
  • Phone: 724-991-6024
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberRP459612
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: