Provider Demographics
NPI:1861119505
Name:TAYLOR, JARED MATTHEW AARON (RPH)
Entity type:Individual
Prefix:MR
First Name:JARED
Middle Name:MATTHEW AARON
Last Name:TAYLOR
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:63 POPLAR LN
Mailing Address - Street 2:
Mailing Address - City:GLENWOOD
Mailing Address - State:GA
Mailing Address - Zip Code:30428-4351
Mailing Address - Country:US
Mailing Address - Phone:912-423-0485
Mailing Address - Fax:912-537-1914
Practice Address - Street 1:63 POPLAR LN
Practice Address - Street 2:
Practice Address - City:GLENWOOD
Practice Address - State:GA
Practice Address - Zip Code:30428-4351
Practice Address - Country:US
Practice Address - Phone:912-423-0485
Practice Address - Fax:912-537-1914
Is Sole Proprietor?:No
Enumeration Date:2022-10-24
Last Update Date:2022-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA030118183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist