Provider Demographics
NPI:1194481762
Name:KABOORD, TAYLOR (PHARMD)
Entity type:Individual
Prefix:
First Name:TAYLOR
Middle Name:
Last Name:KABOORD
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 1:3801 N RICHMOND ST
Mailing Address - Street 2:
Mailing Address - City:APPLETON
Mailing Address - State:WI
Mailing Address - Zip Code:54913-9631
Mailing Address - Country:US
Mailing Address - Phone:920-350-6210
Mailing Address - Fax:920-350-6265
Practice Address - Street 1:3801 N RICHMOND ST
Practice Address - Street 2:
Practice Address - City:APPLETON
Practice Address - State:WI
Practice Address - Zip Code:54913-9631
Practice Address - Country:US
Practice Address - Phone:920-350-6210
Practice Address - Fax:920-350-6265
Is Sole Proprietor?:Yes
Enumeration Date:2021-11-09
Last Update Date:2021-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI21108183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist