Provider Demographics
NPI:1407102684
Name:TALLEY, JOHN FLOYD (RPH)
Entity Type:Individual
Prefix:MR
First Name:JOHN
Middle Name:FLOYD
Last Name:TALLEY
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 1:1625 HIGHWAY 51
Mailing Address - Street 2:
Mailing Address - City:PONCHATOULA
Mailing Address - State:LA
Mailing Address - Zip Code:70454-6593
Mailing Address - Country:US
Mailing Address - Phone:985-386-2232
Mailing Address - Fax:985-386-2269
Practice Address - Street 1:1625 HIGHWAY 51
Practice Address - Street 2:SUITE K
Practice Address - City:PONCHATOULA
Practice Address - State:LA
Practice Address - Zip Code:70454-6593
Practice Address - Country:US
Practice Address - Phone:985-386-2232
Practice Address - Fax:985-386-2269
Is Sole Proprietor?:Yes
Enumeration Date:2012-07-25
Last Update Date:2020-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAPST.015023183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA2201034Medicaid