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General NPI Number Information
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NPI Number | 1770645475
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Entity Type | Organization
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Legal Business Name | TALLENT DRUG STORE
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Dates
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Enumeration Date | 12/16/2006
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Last Update Date | 06/17/2008
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Provider Practice Location Address
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Address Line | 126 COLLEGE ST
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City | MADISONVILLE
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State | TN
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Zip | 37354-1474
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Country | US
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Telephone | 423-442-2400
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Fax | 423-442-4006
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Provider Business Mailing Address
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Address Line | 126 COLLEGE ST
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City | MADISONVILLE
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State | TN
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Zip | 37354-1474
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Country | US
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Telephone | 423-442-2400
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Fax | 423-442-4006
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Authorized Official
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Title or Position | PARTNER PHARMACIST
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Name | E. R. DYKES
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Credential | D.PH
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Telephone | 423-442-2400
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 332B00000X
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Taxonomy Name | Durable Medical Equipment & Medical Supplies
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License Number | 653
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License Number State | TN
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Taxonomy #2
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Taxonomy Code | 183500000X
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Taxonomy Name | Pharmacist
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License Number | 653
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License Number State | TN
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