Provider Demographics
NPI:1619208493
Name:TALBOTT, DEDE R (RPH)
Entity Type:Individual
Prefix:MRS
First Name:DEDE
Middle Name:R
Last Name:TALBOTT
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:PO BOX 215
Mailing Address - Street 2:
Mailing Address - City:UNION
Mailing Address - State:WV
Mailing Address - Zip Code:24983-0215
Mailing Address - Country:US
Mailing Address - Phone:304-772-5701
Mailing Address - Fax:304-772-3239
Practice Address - Street 1:100 MAIN STREET
Practice Address - Street 2:
Practice Address - City:UNION
Practice Address - State:WV
Practice Address - Zip Code:24983-0215
Practice Address - Country:US
Practice Address - Phone:304-772-5701
Practice Address - Fax:304-772-3239
Is Sole Proprietor?:Yes
Enumeration Date:2010-01-19
Last Update Date:2010-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WVRP0005146183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist