Provider Demographics
NPI:1144991647
Name:PEVETO, TAYLOR (PHARMD)
Entity type:Individual
Prefix:
First Name:TAYLOR
Middle Name:
Last Name:PEVETO
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5457 GILBERT DR
Mailing Address - Street 2:
Mailing Address - City:ORANGE
Mailing Address - State:TX
Mailing Address - Zip Code:77632-3614
Mailing Address - Country:US
Mailing Address - Phone:409-313-1985
Mailing Address - Fax:
Practice Address - Street 1:1615 INTERSTATE 10 S
Practice Address - Street 2:
Practice Address - City:BEAUMONT
Practice Address - State:TX
Practice Address - Zip Code:77701-4759
Practice Address - Country:US
Practice Address - Phone:409-840-9776
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-09-23
Last Update Date:2021-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX69283183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist