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General NPI Number Information
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NPI Number | 1780151035
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Entity Type | Individual
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Provider Name | TAYLOR SCOTT MIDDLETON PHARMD
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Gender | Male
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Dates
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Enumeration Date | 10/25/2018
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Last Update Date | 08/20/2019
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Provider Practice Location Address
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Address Line | 516 E NIZHONI BLVD
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City | GALLUP
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State | NM
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Zip | 87301-5748
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Country | US
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Telephone | 505-722-1185
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Fax |
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Provider Business Mailing Address
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Address Line | 8055 W EASTMAN PL UNIT 203
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City | LAKEWOOD
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State | CO
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Zip | 80227-6326
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Country | US
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Telephone | 951-551-5660
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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 | PHA.0022347
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License Number State | CO
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