Provider Demographics
NPI:1508957606
Name:TALLENT, JAMES STEVEN
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:STEVEN
Last Name:TALLENT
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:104 SHANNADOAH LN
Mailing Address - Street 2:
Mailing Address - City:MADISONVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37354-5380
Mailing Address - Country:US
Mailing Address - Phone:423-442-5265
Mailing Address - Fax:423-442-5057
Practice Address - Street 1:4249 HIGHWAY 411
Practice Address - Street 2:UNIT 5
Practice Address - City:MADISONVILLE
Practice Address - State:TN
Practice Address - Zip Code:37354-1544
Practice Address - Country:US
Practice Address - Phone:423-442-9727
Practice Address - Fax:423-442-5057
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-27
Last Update Date:2009-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN4957183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist