Provider Demographics
NPI:1952532913
Name:TALLEY, BRENT WALKER (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:BRENT
Middle Name:WALKER
Last Name:TALLEY
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2000 FAIRVIEW RD
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27608-2374
Mailing Address - Country:US
Mailing Address - Phone:919-832-4641
Mailing Address - Fax:919-832-0291
Practice Address - Street 1:2000 FAIRVIEW RD
Practice Address - Street 2:
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27608-2374
Practice Address - Country:US
Practice Address - Phone:919-832-4641
Practice Address - Fax:919-832-0291
Is Sole Proprietor?:Yes
Enumeration Date:2009-08-06
Last Update Date:2010-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC18391183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist