Provider Demographics
NPI:1437391661
Name:TALBOT, MARY CATHERINE (RPH)
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:CATHERINE
Last Name:TALBOT
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:MARY
Other - Middle Name:CATHERINE
Other - Last Name:POLIZZI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RPH
Mailing Address - Street 1:3816 FAIRFAX DR
Mailing Address - Street 2:
Mailing Address - City:TROY
Mailing Address - State:MI
Mailing Address - Zip Code:48083-6409
Mailing Address - Country:US
Mailing Address - Phone:248-689-9625
Mailing Address - Fax:
Practice Address - Street 1:3251 SOUTH BLVD
Practice Address - Street 2:
Practice Address - City:AUBURN HILLS
Practice Address - State:MI
Practice Address - Zip Code:48326-3635
Practice Address - Country:US
Practice Address - Phone:248-852-5977
Practice Address - Fax:248-852-0062
Is Sole Proprietor?:Yes
Enumeration Date:2009-04-02
Last Update Date:2009-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5302024969183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist