=====================================================
General NPI Number Information
=====================================================
NPI Number | 1811469182
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | TAYLOR JAMES BIRD
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/26/2018
-----------------------------------------------------
Last Update Date | 12/26/2018
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 476 CANAL ST
-----------------------------------------------------
City | BRATTLEBORO
-----------------------------------------------------
State | VT
-----------------------------------------------------
Zip | 05301-6621
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 802-254-5633
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 25 FRANKLIN ST APT F
-----------------------------------------------------
City | EASTHAMPTON
-----------------------------------------------------
State | MA
-----------------------------------------------------
Zip | 01027-1733
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 413-212-1500
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 183500000X
-----------------------------------------------------
Taxonomy Name | Pharmacist
-----------------------------------------------------
License Number | PH238575
-----------------------------------------------------
License Number State | MA
-----------------------------------------------------