Provider Demographics
NPI:1700237252
Name:TALBOT, JEFFREY
Entity Type:Individual
Prefix:
First Name:JEFFREY
Middle Name:
Last Name:TALBOT
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 1:303 LESTER RD
Mailing Address - Street 2:
Mailing Address - City:GRISWOLD
Mailing Address - State:CT
Mailing Address - Zip Code:06351-1436
Mailing Address - Country:US
Mailing Address - Phone:860-367-1394
Mailing Address - Fax:
Practice Address - Street 1:27 MAIN ST
Practice Address - Street 2:
Practice Address - City:JEWETT CITY
Practice Address - State:CT
Practice Address - Zip Code:06351-2203
Practice Address - Country:US
Practice Address - Phone:860-376-1206
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-06-27
Last Update Date:2023-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CTPCT.0013664183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist