MEDICARE: JOSHUA JORDAN TALLEY PHARMD

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	1835P0018X	Pharmacist Clinician (PhC)/ Clinical Pharmacy Specialist	PD15027	AR

General Provider Information

NPI Number	:	1922694686
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JOSHUA JORDAN TALLEY PHARMD

Provider Business Mailing Address
First Line	:	2509 MCCAIN BLVD
Second Line	:
City	:	NORTH LITTLE ROCK
State	:	AR
Zip	:	72116-7606
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2509 MCCAIN BLVD
Second Line	:
City	:	NORTH LITTLE ROCK
State	:	AR
Zip	:	72116-7687
Country	:	US
Telephone Number	:	501-758-9307
Fax Number	:

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

Provider Enumeration Date	:	12/17/2020
Last Update Date	:	01/12/2021

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