Provider Demographics
NPI:1578240156
Name:HADDOCK, TAYLOR KAY (PHARMD)
Entity type:Individual
Prefix:
First Name:TAYLOR
Middle Name:KAY
Last Name:HADDOCK
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13380 HIGHWAY PP
Mailing Address - Street 2:
Mailing Address - City:NEW HARTFORD
Mailing Address - State:MO
Mailing Address - Zip Code:63359-2526
Mailing Address - Country:US
Mailing Address - Phone:573-470-9017
Mailing Address - Fax:
Practice Address - Street 1:1000 E 24TH ST
Practice Address - Street 2:
Practice Address - City:KANSAS CITY
Practice Address - State:MO
Practice Address - Zip Code:64108-2776
Practice Address - Country:US
Practice Address - Phone:816-512-7479
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-07-05
Last Update Date:2024-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE17909183500000X
MO2024024067183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist