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General NPI Number Information
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NPI Number | 1194807701
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Entity Type | Organization
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Legal Business Name | TALLEY ENTERPRISES
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Dates
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Enumeration Date | 10/20/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 511 W MAIN ST
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City | HOMER
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State | LA
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Zip | 71040-3929
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Country | US
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Telephone | 318-927-3535
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Fax | 318-927-9501
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Provider Business Mailing Address
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Address Line | 511 W MAIN ST
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City | HOMER
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State | LA
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Zip | 71040-3929
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Country | US
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Telephone | 318-927-3535
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Fax | 318-927-9501
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Authorized Official
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Title or Position | OWNER PHARMACIST
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Name | MR. LARRY J TALLEY
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Credential | RPH.
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Telephone | 318-927-3535
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 183500000X
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Taxonomy Name | Pharmacist
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License Number | 174-IR
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License Number State | LA
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