Provider Demographics
NPI:1114096542
Name:MUSGROVE, TALMAGE THOMAS III (RPH)
Entity Type:Individual
Prefix:MR
First Name:TALMAGE
Middle Name:THOMAS
Last Name:MUSGROVE
Suffix:III
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 1:7016 FIRE TOWER ROAD
Mailing Address - Street 2:
Mailing Address - City:ZUNI
Mailing Address - State:VA
Mailing Address - Zip Code:23898-2220
Mailing Address - Country:US
Mailing Address - Phone:757-242-9002
Mailing Address - Fax:
Practice Address - Street 1:328 W MAIN ST
Practice Address - Street 2:
Practice Address - City:WAVERLY
Practice Address - State:VA
Practice Address - Zip Code:23890-0596
Practice Address - Country:US
Practice Address - Phone:804-834-2233
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-11-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0202004077183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist