Provider Demographics
NPI:1881778454
Name:TALLMANS PHARMACY INC
Entity type:Organization
Organization Name:TALLMANS PHARMACY INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:COLETTE
Authorized Official - Middle Name:
Authorized Official - Last Name:RICHMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:509-525-1010
Mailing Address - Street 1:4 W MAIN ST
Mailing Address - Street 2:
Mailing Address - City:WALLA WALLA
Mailing Address - State:WA
Mailing Address - Zip Code:99362-2816
Mailing Address - Country:US
Mailing Address - Phone:509-525-1010
Mailing Address - Fax:509-525-8341
Practice Address - Street 1:4 W MAIN ST
Practice Address - Street 2:
Practice Address - City:WALLA WALLA
Practice Address - State:WA
Practice Address - Zip Code:99362-2816
Practice Address - Country:US
Practice Address - Phone:509-525-1010
Practice Address - Fax:509-525-8341
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-24
Last Update Date:2016-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACF601550403336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2125336OtherPK
4901319OtherNCPDP PROVIDER IDENTIFICATION NUMBER