Provider Demographics
NPI:1194711812
Name:THORNTON-TAYLOR, MICHELLE L (RPH)
Entity type:Individual
Prefix:
First Name:MICHELLE
Middle Name:L
Last Name:THORNTON-TAYLOR
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1490 SUNSHADOW DRIVE
Mailing Address - Street 2:STE 3020
Mailing Address - City:CASSELBERRY
Mailing Address - State:FL
Mailing Address - Zip Code:32707-9055
Mailing Address - Country:US
Mailing Address - Phone:855-497-7956
Mailing Address - Fax:855-497-7957
Practice Address - Street 1:1490 SUNSHADOW DRIVE
Practice Address - Street 2:STE 3020
Practice Address - City:CASSELBERRY
Practice Address - State:FL
Practice Address - Zip Code:32707-9055
Practice Address - Country:US
Practice Address - Phone:855-497-7956
Practice Address - Fax:855-497-7957
Is Sole Proprietor?:Yes
Enumeration Date:2005-09-27
Last Update Date:2016-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS21492183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist