Provider Demographics
NPI:1366619629
Name:TRAYLOR, DARRYL (RPH)
Entity type:Individual
Prefix:
First Name:DARRYL
Middle Name:
Last Name:TRAYLOR
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19160 GREENFIELD RD
Mailing Address - Street 2:RITE-AID 4414
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48235-2001
Mailing Address - Country:US
Mailing Address - Phone:313-862-2603
Mailing Address - Fax:313-862-4606
Practice Address - Street 1:19160 GREENFIELD RD
Practice Address - Street 2:RITE-AID 4414
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48235-2001
Practice Address - Country:US
Practice Address - Phone:313-862-2603
Practice Address - Fax:313-862-4606
Is Sole Proprietor?:No
Enumeration Date:2008-05-14
Last Update Date:2008-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5302410846183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist