Provider Demographics
NPI:1902189400
Name:TALBOT, TERRY LYNN (R PH)
Entity Type:Individual
Prefix:MS
First Name:TERRY
Middle Name:LYNN
Last Name:TALBOT
Suffix:
Gender:F
Credentials:R PH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:197 TZ TRL
Mailing Address - Street 2:
Mailing Address - City:GRAND JUNCTION
Mailing Address - State:CO
Mailing Address - Zip Code:81503-9614
Mailing Address - Country:US
Mailing Address - Phone:970-314-7718
Mailing Address - Fax:
Practice Address - Street 1:2900 NORTH AVE
Practice Address - Street 2:
Practice Address - City:GRAND JUNCTION
Practice Address - State:CO
Practice Address - Zip Code:81504-5315
Practice Address - Country:US
Practice Address - Phone:970-208-1014
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-09-21
Last Update Date:2011-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO13280183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist