Provider Demographics
NPI:1861607889
Name:TAYLOR, BRUCE SAMUEL (RPH)
Entity type:Individual
Prefix:MR
First Name:BRUCE
Middle Name:SAMUEL
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 1:12805 PRINCELEIGH ST
Mailing Address - Street 2:
Mailing Address - City:UPPER MARLBORO
Mailing Address - State:MD
Mailing Address - Zip Code:20774-1708
Mailing Address - Country:US
Mailing Address - Phone:240-501-1180
Mailing Address - Fax:
Practice Address - Street 1:12805 PRINCELEIGH ST
Practice Address - Street 2:
Practice Address - City:UPPER MARLBORO
Practice Address - State:MD
Practice Address - Zip Code:20774-1708
Practice Address - Country:US
Practice Address - Phone:240-501-1180
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD11327183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist