Provider Demographics
NPI:1366721466
Name:GROSSE, TAYLOR SAULS (PHARM D)
Entity type:Individual
Prefix:MRS
First Name:TAYLOR
Middle Name:SAULS
Last Name:GROSSE
Suffix:
Gender:F
Credentials:PHARM D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:600 BUCKSLEY LN
Mailing Address - Street 2:UNIT 103
Mailing Address - City:DANIEL ISLAND
Mailing Address - State:SC
Mailing Address - Zip Code:29492-8184
Mailing Address - Country:US
Mailing Address - Phone:770-402-5671
Mailing Address - Fax:
Practice Address - Street 1:1300 LONG GROVE DR
Practice Address - Street 2:
Practice Address - City:MOUNT PLEASANT
Practice Address - State:SC
Practice Address - Zip Code:29464-9462
Practice Address - Country:US
Practice Address - Phone:843-388-1973
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-08-08
Last Update Date:2011-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SCSC13410183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist