Basic Information
| Provider Information | |||||||||
| NPI: | 1063988236 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | TAYLOR | ||||||||
| FirstName: | ARNOLD | ||||||||
| MiddleName: | RICARDO | ||||||||
| NamePrefix: | |||||||||
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| Credential: | PHARMD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 7421 DOUGLAS BLVD STE N415 | ||||||||
| Address2: | |||||||||
| City: | DOUGLASVILLE | ||||||||
| State: | GA | ||||||||
| PostalCode: | 301351564 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7709421044 | ||||||||
| FaxNumber: | 7709421699 | ||||||||
| Practice Location | |||||||||
| Address1: | 6853 DOUGLAS BLVD STE A | ||||||||
| Address2: | |||||||||
| City: | DOUGLASVILLE | ||||||||
| State: | GA | ||||||||
| PostalCode: | 301357178 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7709421044 | ||||||||
| FaxNumber: | 7709421699 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/15/2018 | ||||||||
| LastUpdateDate: | 08/21/2019 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 183500000X | RPH021316 | GA | Y | Pharmacy Service Providers | Pharmacist |
No ID Information.