Provider Demographics
NPI:1831879147
Name:DUQUE, TAYLOR M (PHARMD)
Entity type:Individual
Prefix:
First Name:TAYLOR
Middle Name:M
Last Name:DUQUE
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:TAYLOR
Other - Middle Name:M
Other - Last Name:BORMANN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PHARMD
Mailing Address - Street 1:1285 EDGEHILL RD APT 37
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43212-3176
Mailing Address - Country:US
Mailing Address - Phone:614-949-6448
Mailing Address - Fax:
Practice Address - Street 1:700 CHILDRENS DR
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43205-2664
Practice Address - Country:US
Practice Address - Phone:614-949-6448
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-07-20
Last Update Date:2024-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH03443370183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist