Basic Information
| Provider Information | |||||||||
| NPI: | 1073111241 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | KIRKLAND | ||||||||
| FirstName: | TAYLOR | ||||||||
| MiddleName: | RENEE | ||||||||
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| Credential: | PHARMD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 917 ABERNATHY ST | ||||||||
| Address2: | |||||||||
| City: | MADISONVILLE | ||||||||
| State: | TN | ||||||||
| PostalCode: | 373541267 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4235195589 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 4110 SHALLOWFORD RD | ||||||||
| Address2: | |||||||||
| City: | CHATTANOOGA | ||||||||
| State: | TN | ||||||||
| PostalCode: | 374111110 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4232420019 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/11/2020 | ||||||||
| LastUpdateDate: | 10/11/2020 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 08/28/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 183500000X | 44306 | TN | Y | Pharmacy Service Providers | Pharmacist | 183500000X | RPH032296 | GA | N | Pharmacy Service Providers | Pharmacist |
No ID Information.