Provider Demographics
NPI:1427305705
Name:TAYLOR, STACY BROWN
Entity type:Individual
Prefix:MRS
First Name:STACY
Middle Name:BROWN
Last Name:TAYLOR
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 1:1102 HADDON HALL DR
Mailing Address - Street 2:
Mailing Address - City:APEX
Mailing Address - State:NC
Mailing Address - Zip Code:27502-5275
Mailing Address - Country:US
Mailing Address - Phone:919-219-2967
Mailing Address - Fax:919-362-5574
Practice Address - Street 1:1802 S HORNER BLVD
Practice Address - Street 2:
Practice Address - City:SANFORD
Practice Address - State:NC
Practice Address - Zip Code:27330-5839
Practice Address - Country:US
Practice Address - Phone:919-774-9456
Practice Address - Fax:919-776-4072
Is Sole Proprietor?:No
Enumeration Date:2012-08-06
Last Update Date:2012-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC13444183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist