=====================================================
General NPI Number Information
=====================================================
NPI Number | 1205841848
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | TAYLOR PHARMACY GROUP LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/30/2006
-----------------------------------------------------
Last Update Date | 12/10/2015
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2407 N MAIN ST
-----------------------------------------------------
City | TAYLOR
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 76574-1833
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 512-352-3659
-----------------------------------------------------
Fax | 512-352-8282
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 1244
-----------------------------------------------------
City | TAYLOR
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 76574-6244
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 512-352-3659
-----------------------------------------------------
Fax | 512-352-8282
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER/PIC
-----------------------------------------------------
Name | MICHAEL HERRERA
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 512-352-3659
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 3336L0003X
-----------------------------------------------------
Taxonomy Name | Long Term Care Pharmacy
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 3336C0003X
-----------------------------------------------------
Taxonomy Name | Community/Retail Pharmacy
-----------------------------------------------------
License Number | 29899
-----------------------------------------------------
License Number State | TX
-----------------------------------------------------