Healthcare Provider Details

I. General information

NPI: 1205841848
Provider Name (Legal Business Name): TAYLOR PHARMACY GROUP LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/30/2006
Last Update Date: 12/10/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2407 N MAIN ST
TAYLOR TX
76574-1833
US

IV. Provider business mailing address

PO BOX 1244
TAYLOR TX
76574-6244
US

V. Phone/Fax

Practice location:
  • Phone: 512-352-3659
  • Fax: 512-352-8282
Mailing address:
  • Phone: 512-352-3659
  • Fax: 512-352-8282

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number29899
License Number StateTX
# 2
Primary TaxonomyN
Taxonomy Code3336L0003X
TaxonomyLong Term Care Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: MICHAEL HERRERA
Title or Position: OWNER/PIC
Credential:
Phone: 512-352-3659