Healthcare Provider Details

I. General information

NPI: 1457679060
Provider Name (Legal Business Name): ROBERT E TAYLOR PHARMACIST
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/06/2010
Last Update Date: 05/06/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5300 REDBUD HWY
HONAKER VA
24260
US

IV. Provider business mailing address

PO BOX 742
HONAKER VA
24260-0742
US

V. Phone/Fax

Practice location:
  • Phone: 276-873-6132
  • Fax: 276-873-4614
Mailing address:
  • Phone: 276-873-6132
  • Fax: 276-873-4614

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number0202004501
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: