MEDICARE: TIMOTHY TALBOT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	183500000X	Pharmacist	PHA.0024603	CO

General Provider Information

NPI Number	:	1568242279
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TIMOTHY TALBOT

Provider Business Mailing Address
First Line	:	214 W ALABAMA AVE
Second Line	:
City	:	FOUNTAIN
State	:	CO
Zip	:	80817-1802
Country	:	US
Telephone Number	:	720-233-8152
Fax Number	:

Provider Business Practice Location Address
First Line	:	1121 N CIRCLE DR
Second Line	:
City	:	COLORADO SPRINGS
State	:	CO
Zip	:	80909-3134
Country	:	US
Telephone Number	:	719-573-6061
Fax Number	:	719-573-1059

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/02/2023
Last Update Date	:	10/19/2023

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Directions to “ TIMOTHY TALBOT ” Practice Location

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