MEDICARE: DR. KIMBERLY SUZANNE TAYLOR PHARM.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	183500000X	Pharmacist	35994	TN
2	183500000X	Pharmacist	E-11703	MS

General Provider Information

NPI Number	:	1629335302
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. KIMBERLY SUZANNE TAYLOR PHARM.D.

Provider Business Mailing Address
First Line	:	1319 BROADMOOR ST
Second Line	:
City	:	MEMPHIS
State	:	TN
Zip	:	38111-7310
Country	:	US
Telephone Number	:	731-693-4649
Fax Number	:

Provider Business Practice Location Address
First Line	:	1936 W POPLAR AVE
Second Line	:
City	:	COLLIERVILLE
State	:	TN
Zip	:	38017-0605
Country	:	US
Telephone Number	:	901-853-6012
Fax Number	:	901-854-7630

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/18/2012
Last Update Date	:	12/10/2012

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