Provider Demographics
NPI:1871186866
Name:TAYLOR, KENT (RPH)
Entity type:Individual
Prefix:
First Name:KENT
Middle Name:
Last Name:TAYLOR
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:367 E 1400 N
Mailing Address - Street 2:
Mailing Address - City:MAPLETON
Mailing Address - State:UT
Mailing Address - Zip Code:84664-3826
Mailing Address - Country:US
Mailing Address - Phone:801-319-2345
Mailing Address - Fax:
Practice Address - Street 1:286 W CENTER ST
Practice Address - Street 2:
Practice Address - City:PROVO
Practice Address - State:UT
Practice Address - Zip Code:84601-4419
Practice Address - Country:US
Practice Address - Phone:801-373-7288
Practice Address - Fax:801-373-0673
Is Sole Proprietor?:No
Enumeration Date:2021-02-19
Last Update Date:2021-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT6046694183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist