Healthcare Provider Details

I. General information

NPI: 1154457380
Provider Name (Legal Business Name): KOBY TAYLOR PHARM.D., R.PH.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/23/2007
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1100 CANYON VIEW DR STE C
SANTA CLARA UT
84765-5672
US

IV. Provider business mailing address

1100 CANYON VIEW DR STE C
SANTA CLARA UT
84765-5672
US

V. Phone/Fax

Practice location:
  • Phone: 435-703-9680
  • Fax: 855-853-3465
Mailing address:
  • Phone: 435-703-9680
  • Fax: 855-853-3465

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number333234-1701
License Number StateUT
# 2
Primary TaxonomyN
Taxonomy Code1835N1003X
TaxonomyNutrition Support Pharmacist
License Number333234
License Number StateUT
# 3
Primary TaxonomyN
Taxonomy Code1835P1200X
TaxonomyPharmacotherapy Pharmacist
License Number333234
License Number StateUT
# 4
Primary TaxonomyN
Taxonomy Code1835G0303X
TaxonomyGeriatric Pharmacist
License Number333234
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: