Provider Demographics
NPI:1952095002
Name:TALBOTT, ANDREA (CPHT)
Entity Type:Individual
Prefix:MRS
First Name:ANDREA
Middle Name:
Last Name:TALBOTT
Suffix:
Gender:F
Credentials:CPHT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 115
Mailing Address - Street 2:
Mailing Address - City:FINGER
Mailing Address - State:TN
Mailing Address - Zip Code:38334-0115
Mailing Address - Country:US
Mailing Address - Phone:731-608-1629
Mailing Address - Fax:
Practice Address - Street 1:535 W MAIN ST
Practice Address - Street 2:
Practice Address - City:HENDERSON
Practice Address - State:TN
Practice Address - Zip Code:38340-2536
Practice Address - Country:US
Practice Address - Phone:731-989-0077
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-06-02
Last Update Date:2023-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN23404183700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183700000XPharmacy Service ProvidersPharmacy Technician