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General NPI Number Information
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NPI Number | 1063986503
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Entity Type | Individual
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Provider Name | TAYLOR DIGGS MOSTELLER PHARMD
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Gender | Male
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Dates
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Enumeration Date | 01/17/2019
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Last Update Date | 10/21/2024
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Provider Practice Location Address
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Address Line | 589 PROSPECT AVE
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City | BROOKLYN
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State | NY
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Zip | 11215-6020
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Country | US
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Telephone | 347-955-3029
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Fax |
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Provider Business Mailing Address
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Address Line | 678 SAINT MARKS AVE APT 2F
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City | BROOKLYN
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State | NY
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Zip | 11216-3636
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Country | US
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Telephone | 864-534-3867
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 183500000X
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Taxonomy Name | Pharmacist
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License Number | 071685
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License Number State | NY
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