Provider Demographics
NPI:1902079825
Name:TAYLOR, FREDERICK D (PD)
Entity Type:Individual
Prefix:
First Name:FREDERICK
Middle Name:D
Last Name:TAYLOR
Suffix:
Gender:M
Credentials:PD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7200 LENA WAY
Mailing Address - Street 2:
Mailing Address - City:BOWIE
Mailing Address - State:MD
Mailing Address - Zip Code:20715-6023
Mailing Address - Country:US
Mailing Address - Phone:301-352-0195
Mailing Address - Fax:
Practice Address - Street 1:7200 LENA WAY
Practice Address - Street 2:
Practice Address - City:BOWIE
Practice Address - State:MD
Practice Address - Zip Code:20715-6023
Practice Address - Country:US
Practice Address - Phone:301-352-0195
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-04-11
Last Update Date:2008-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD13219183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist