Provider Demographics
NPI:1285710913
Name:SCOTT A. TAYLOR
Entity type:Organization
Organization Name:SCOTT A. TAYLOR
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER CHIEF PHARMACIST
Authorized Official - Prefix:
Authorized Official - First Name:SCOTT
Authorized Official - Middle Name:A
Authorized Official - Last Name:TAYLOR
Authorized Official - Suffix:
Authorized Official - Credentials:RP
Authorized Official - Phone:402-748-3708
Mailing Address - Street 1:322 STATE STREET
Mailing Address - Street 2:
Mailing Address - City:OSMOND
Mailing Address - State:NE
Mailing Address - Zip Code:68765-0036
Mailing Address - Country:US
Mailing Address - Phone:402-749-3708
Mailing Address - Fax:402-748-3812
Practice Address - Street 1:322 STATE STREET
Practice Address - Street 2:
Practice Address - City:OSMOND
Practice Address - State:NE
Practice Address - Zip Code:68765-0036
Practice Address - Country:US
Practice Address - Phone:402-749-3708
Practice Address - Fax:402-748-3812
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-27
Last Update Date:2008-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2813550OtherNCPDP
NE=========00Medicaid
NE=========00Medicaid