Provider Demographics
NPI:1538625686
Name:TAYLOR PHARMACY GROUP, INC.
Entity type:Organization
Organization Name:TAYLOR PHARMACY GROUP, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JILLIAN
Authorized Official - Middle Name:BROOKE
Authorized Official - Last Name:TAYLOR
Authorized Official - Suffix:
Authorized Official - Credentials:PHARM D
Authorized Official - Phone:912-496-2044
Mailing Address - Street 1:3885 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:FOLKSTON
Mailing Address - State:GA
Mailing Address - Zip Code:31537-7543
Mailing Address - Country:US
Mailing Address - Phone:912-496-2044
Mailing Address - Fax:912-496-3329
Practice Address - Street 1:3885 MAIN ST
Practice Address - Street 2:
Practice Address - City:FOLKSTON
Practice Address - State:GA
Practice Address - Zip Code:31537-7543
Practice Address - Country:US
Practice Address - Phone:912-496-2044
Practice Address - Fax:912-496-3329
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-02-13
Last Update Date:2020-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
GAPHRE010695OtherSTATE PHARMACY PERMIT