Provider Demographics
NPI:1154801850
Name:GARDNER, TAYLOR (PHARMD)
Entity type:Individual
Prefix:
First Name:TAYLOR
Middle Name:
Last Name:GARDNER
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2684 COSTA MESA DR
Mailing Address - Street 2:
Mailing Address - City:LITTLE ELM
Mailing Address - State:TX
Mailing Address - Zip Code:75068-3407
Mailing Address - Country:US
Mailing Address - Phone:307-752-5480
Mailing Address - Fax:
Practice Address - Street 1:8055 CHURCHILL WAY
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75251-2149
Practice Address - Country:US
Practice Address - Phone:469-680-7556
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-08-21
Last Update Date:2018-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX61287183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist