Provider Demographics
NPI:1306190277
Name:TALANKI, NAGA PRASANNA (RPH)
Entity Type:Individual
Prefix:
First Name:NAGA
Middle Name:PRASANNA
Last Name:TALANKI
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1748 KIRTS BLVD
Mailing Address - Street 2:102
Mailing Address - City:TROY
Mailing Address - State:MI
Mailing Address - Zip Code:48084-4343
Mailing Address - Country:US
Mailing Address - Phone:303-502-5295
Mailing Address - Fax:
Practice Address - Street 1:1570 E PIERSON RD
Practice Address - Street 2:
Practice Address - City:FLUSHING
Practice Address - State:MI
Practice Address - Zip Code:48433-1817
Practice Address - Country:US
Practice Address - Phone:810-659-1062
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-10-31
Last Update Date:2012-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5302040233183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist