1790999514 NPI number — DR. REBECCA ANN TAYLOR PHARM.D.

Table of content: NAOMI MCNUTT (NPI 1508652777)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1790999514 NPI number — DR. REBECCA ANN TAYLOR PHARM.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
TAYLOR
Provider First Name:
REBECCA
Provider Middle Name:
ANN
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
PHARM.D.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
GODESKY
Provider Other First Name:
REBECCA
Provider Other Middle Name:
ANN
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
PHARM.D.
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1790999514
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
207 E ROSELAWN ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
DANVILLE
Provider Business Mailing Address State Name:
IL
Provider Business Mailing Address Postal Code:
61832-2420
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
217-443-4250
Provider Business Mailing Address Fax Number:
217-443-5249

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
812 N LOGAN AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
DANVILLE
Provider Business Practice Location Address State Name:
IL
Provider Business Practice Location Address Postal Code:
61832-3752
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
217-443-5250
Provider Business Practice Location Address Fax Number:
217-443-5249
Provider Enumeration Date:
05/10/2007

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 1835P1200X , registered in the state of IL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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