Healthcare Provider Details

I. General information

NPI: 1346068780
Provider Name (Legal Business Name): LEE GRAFTON TAYLOR PHARMD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/02/2024
Last Update Date: 10/15/2024
Certification Date: 10/15/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

19 HUGHES DR
JACKSON TN
38305-1510
US

IV. Provider business mailing address

19 HUGHES DR
JACKSON TN
38305-1510
US

V. Phone/Fax

Practice location:
  • Phone: 731-668-9072
  • Fax:
Mailing address:
  • Phone: 731-668-9072
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1835P0018X
TaxonomyPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
License Number47785
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: