Provider Demographics
NPI:1730493602
Name:TALLEY, RICHARD L (PHARMACIST)
Entity Type:Individual
Prefix:
First Name:RICHARD
Middle Name:L
Last Name:TALLEY
Suffix:
Gender:M
Credentials:PHARMACIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:440 N GRETNA GREEN DR
Mailing Address - Street 2:
Mailing Address - City:MUNFORD
Mailing Address - State:TN
Mailing Address - Zip Code:38058-2609
Mailing Address - Country:US
Mailing Address - Phone:901-837-8228
Mailing Address - Fax:
Practice Address - Street 1:44 TABB DR
Practice Address - Street 2:
Practice Address - City:MUNFORD
Practice Address - State:TN
Practice Address - Zip Code:38058
Practice Address - Country:US
Practice Address - Phone:901-840-2450
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-08-03
Last Update Date:2010-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN3628183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist