Provider Demographics
NPI:1285156521
Name:TAILOR, SONA
Entity type:Individual
Prefix:
First Name:SONA
Middle Name:
Last Name:TAILOR
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:225 POLO HILL RD
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:SC
Mailing Address - Zip Code:29223-2839
Mailing Address - Country:US
Mailing Address - Phone:870-262-7580
Mailing Address - Fax:
Practice Address - Street 1:1706 S CANNON BLVD
Practice Address - Street 2:
Practice Address - City:KANNAPOLIS
Practice Address - State:NC
Practice Address - Zip Code:28083-6104
Practice Address - Country:US
Practice Address - Phone:704-933-6337
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-07-07
Last Update Date:2021-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC37169183500000X
NC29837183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC29837OtherPHARMACIST LICENSE