Provider Demographics
NPI:1205004017
Name:TALBOT, ADAM J (RPH)
Entity Type:Individual
Prefix:MR
First Name:ADAM
Middle Name:J
Last Name:TALBOT
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 1:5200 HILLTOP DRIVE S-2
Mailing Address - Street 2:
Mailing Address - City:BROOKHAVEN
Mailing Address - State:PA
Mailing Address - Zip Code:19015
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:643 CONCHESTER HIGHWAY
Practice Address - Street 2:SUPER FRESH PHARMACY
Practice Address - City:BOOTHWYN
Practice Address - State:PA
Practice Address - Zip Code:19061
Practice Address - Country:US
Practice Address - Phone:610-859-8930
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-02-14
Last Update Date:2008-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARP036387T183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist