Provider Demographics
NPI:1871972000
Name:TAYLOR, TERRI (RPH)
Entity type:Individual
Prefix:
First Name:TERRI
Middle Name:
Last Name:TAYLOR
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:500 LIMIT ST STE 100
Mailing Address - Street 2:
Mailing Address - City:LEAVENWORTH
Mailing Address - State:KS
Mailing Address - Zip Code:66048-4435
Mailing Address - Country:US
Mailing Address - Phone:913-680-1652
Mailing Address - Fax:913-297-7507
Practice Address - Street 1:500 LIMIT ST STE 100
Practice Address - Street 2:
Practice Address - City:LEAVENWORTH
Practice Address - State:KS
Practice Address - Zip Code:66048-4435
Practice Address - Country:US
Practice Address - Phone:913-680-1652
Practice Address - Fax:913-297-7507
Is Sole Proprietor?:Yes
Enumeration Date:2015-05-20
Last Update Date:2017-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS1-11197183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist