Provider Demographics
NPI:1871061929
Name:TAYLOR, ZACKERY N (PHARMD/MBA)
Entity type:Individual
Prefix:
First Name:ZACKERY
Middle Name:N
Last Name:TAYLOR
Suffix:
Gender:M
Credentials:PHARMD/MBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 303
Mailing Address - Street 2:
Mailing Address - City:BICKNELL
Mailing Address - State:UT
Mailing Address - Zip Code:84715-0303
Mailing Address - Country:US
Mailing Address - Phone:435-425-1140
Mailing Address - Fax:435-425-1139
Practice Address - Street 1:585 W MAIN ST
Practice Address - Street 2:
Practice Address - City:GREEN RIVER
Practice Address - State:UT
Practice Address - Zip Code:84525
Practice Address - Country:US
Practice Address - Phone:435-564-3434
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-11-07
Last Update Date:2018-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT8418517-1701183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist