Provider Demographics
NPI:1750458857
Name:LOWE, TALMADGE RAY SR (PHARMACIST)
Entity Type:Individual
Prefix:
First Name:TALMADGE
Middle Name:RAY
Last Name:LOWE
Suffix:SR
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 1:34 STATELY SHOALS TRL
Mailing Address - Street 2:
Mailing Address - City:PONTE VEDRA
Mailing Address - State:FL
Mailing Address - Zip Code:32081-5053
Mailing Address - Country:US
Mailing Address - Phone:904-823-8626
Mailing Address - Fax:
Practice Address - Street 1:34 STATELY SHOALS TRL
Practice Address - Street 2:
Practice Address - City:PONTE VEDRA
Practice Address - State:FL
Practice Address - Zip Code:32081-5053
Practice Address - Country:US
Practice Address - Phone:904-823-8626
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-30
Last Update Date:2013-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS 11429183500000X, 1835N1003X, 1835P1200X, 1835P1300X, 1835X0200X
FLPU13531835G0303X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
No1835N1003XPharmacy Service ProvidersPharmacistNutrition Support
No1835P1200XPharmacy Service ProvidersPharmacistPharmacotherapy
No1835P1300XPharmacy Service ProvidersPharmacistPsychiatric
No1835X0200XPharmacy Service ProvidersPharmacistOncology
No1835G0303XPharmacy Service ProvidersPharmacistGeriatric