Provider Demographics
NPI:1730857814
Name:ALBERSON, TAYLOR (PHARMD)
Entity type:Individual
Prefix:DR
First Name:TAYLOR
Middle Name:
Last Name:ALBERSON
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:TAYLOR
Other - Middle Name:
Other - Last Name:SKAGGS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:200 BAY SHORE DR
Mailing Address - Street 2:
Mailing Address - City:DECATUR
Mailing Address - State:IL
Mailing Address - Zip Code:62521-5533
Mailing Address - Country:US
Mailing Address - Phone:573-579-6534
Mailing Address - Fax:
Practice Address - Street 1:255 W 1ST DR
Practice Address - Street 2:
Practice Address - City:DECATUR
Practice Address - State:IL
Practice Address - Zip Code:62521-5205
Practice Address - Country:US
Practice Address - Phone:217-428-1778
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-09-02
Last Update Date:2021-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL051304212183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist