Provider Demographics
NPI:1053720060
Name:TAYLOR, MATTHEW TYREL (PHARMACIST)
Entity type:Individual
Prefix:
First Name:MATTHEW
Middle Name:TYREL
Last Name:TAYLOR
Suffix:
Gender:M
Credentials:PHARMACIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2021 N PINAL AVE
Mailing Address - Street 2:
Mailing Address - City:CASA GRANDE
Mailing Address - State:AZ
Mailing Address - Zip Code:85122-1417
Mailing Address - Country:US
Mailing Address - Phone:520-876-0265
Mailing Address - Fax:520-876-0532
Practice Address - Street 1:2021 N PINAL AVE
Practice Address - Street 2:
Practice Address - City:CASA GRANDE
Practice Address - State:AZ
Practice Address - Zip Code:85122-1417
Practice Address - Country:US
Practice Address - Phone:520-876-0265
Practice Address - Fax:520-876-0532
Is Sole Proprietor?:No
Enumeration Date:2014-08-05
Last Update Date:2014-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZS020747183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist