Provider Demographics
NPI:1063172187
Name:BRANHAM, TAYLOR GLENN (PHARMD)
Entity type:Individual
Prefix:DR
First Name:TAYLOR
Middle Name:GLENN
Last Name:BRANHAM
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1095 JOY RD
Mailing Address - Street 2:
Mailing Address - City:HAYDEN
Mailing Address - State:AL
Mailing Address - Zip Code:35079-3129
Mailing Address - Country:US
Mailing Address - Phone:205-363-0672
Mailing Address - Fax:
Practice Address - Street 1:1204 BRINDLEE PARKWAY
Practice Address - Street 2:
Practice Address - City:ARAB
Practice Address - State:AL
Practice Address - Zip Code:35016
Practice Address - Country:US
Practice Address - Phone:256-586-6021
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-12-30
Last Update Date:2021-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN45402183500000X
AL22279183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist