Provider Demographics
NPI:1437591393
Name:GAYNOR, TAYLOR (RPH)
Entity type:Individual
Prefix:
First Name:TAYLOR
Middle Name:
Last Name:GAYNOR
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:TAYLOR
Other - Middle Name:
Other - Last Name:GAUTHIER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RPH
Mailing Address - Street 1:6970 CORPORATE DR
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46278-1928
Mailing Address - Country:US
Mailing Address - Phone:888-696-9595
Mailing Address - Fax:888-881-8585
Practice Address - Street 1:6970 CORPORATE DR
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46278-1928
Practice Address - Country:US
Practice Address - Phone:888-696-9595
Practice Address - Fax:888-881-8585
Is Sole Proprietor?:No
Enumeration Date:2013-07-20
Last Update Date:2017-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH03232633183500000X
IN26026478A183500000X
IL051297452183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist