Provider Demographics
NPI:1447503362
Name:TAYLOR, MARY JANIS (B S PHARMACY)
Entity type:Individual
Prefix:MRS
First Name:MARY
Middle Name:JANIS
Last Name:TAYLOR
Suffix:
Gender:F
Credentials:B S PHARMACY
Other - Prefix:MRS
Other - First Name:JANIS
Other - Middle Name:MCCORMICK
Other - Last Name:TAYLOR
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:323 NASH AVE
Mailing Address - Street 2:
Mailing Address - City:COOKEVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:38501-3692
Mailing Address - Country:US
Mailing Address - Phone:931-982-0191
Mailing Address - Fax:847-747-1608
Practice Address - Street 1:323 NASH AVE
Practice Address - Street 2:
Practice Address - City:COOKEVILLE
Practice Address - State:TN
Practice Address - Zip Code:38501-3692
Practice Address - Country:US
Practice Address - Phone:931-982-0191
Practice Address - Fax:847-747-1608
Is Sole Proprietor?:Yes
Enumeration Date:2012-10-16
Last Update Date:2012-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN33797183500000X
AL13357183500000X
FLPS24191183500000X
MSE07649183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist