Provider Demographics
NPI:1538442264
Name:TAYLOR, DEBRA J (RPH)
Entity type:Individual
Prefix:
First Name:DEBRA
Middle Name:J
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 1:172 EAST MCARTHUR
Mailing Address - Street 2:
Mailing Address - City:BETHALTO
Mailing Address - State:IL
Mailing Address - Zip Code:62024
Mailing Address - Country:US
Mailing Address - Phone:618-259-7056
Mailing Address - Fax:
Practice Address - Street 1:172 E MCARTHUR DR
Practice Address - Street 2:
Practice Address - City:BETHALTO
Practice Address - State:IL
Practice Address - Zip Code:62010-1776
Practice Address - Country:US
Practice Address - Phone:618-259-7056
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-09-20
Last Update Date:2011-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL051033669183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist