=====================================================
General NPI Number Information
=====================================================
NPI Number | 1629929476
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | ALEXIS TALLENT PHARMD
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/06/2026
-----------------------------------------------------
Last Update Date | 02/06/2026
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 16850 STATE HIGHWAY 58 S
-----------------------------------------------------
City | DECATUR
-----------------------------------------------------
State | TN
-----------------------------------------------------
Zip | 37322-5259
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 423-454-0028
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 330 COUNTY ROAD 117
-----------------------------------------------------
City | RICEVILLE
-----------------------------------------------------
State | TN
-----------------------------------------------------
Zip | 37370-5431
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone |
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 183500000X
-----------------------------------------------------
Taxonomy Name | Pharmacist
-----------------------------------------------------
License Number | 48031
-----------------------------------------------------
License Number State | TN
-----------------------------------------------------