Provider Demographics
NPI:1619733300
Name:TALLAROM, PAUL A (RPH)
Entity Type:Individual
Prefix:
First Name:PAUL
Middle Name:A
Last Name:TALLAROM
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 1:224 LONGFELLOW ST STE 100
Mailing Address - Street 2:
Mailing Address - City:VANDERGRIFT
Mailing Address - State:PA
Mailing Address - Zip Code:15690-1476
Mailing Address - Country:US
Mailing Address - Phone:724-567-6615
Mailing Address - Fax:
Practice Address - Street 1:224 LONGFELLOW ST STE 100
Practice Address - Street 2:
Practice Address - City:VANDERGRIFT
Practice Address - State:PA
Practice Address - Zip Code:15690-1476
Practice Address - Country:US
Practice Address - Phone:724-567-6615
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-02-21
Last Update Date:2024-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARP030851L183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PARP030851LOtherPA PHARMACIST LICENSE