Provider Demographics
NPI:1194807701
Name:TALLEY ENTERPRISES
Entity type:Organization
Organization Name:TALLEY ENTERPRISES
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER PHARMACIST
Authorized Official - Prefix:MR
Authorized Official - First Name:LARRY
Authorized Official - Middle Name:J
Authorized Official - Last Name:TALLEY
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:318-927-3535
Mailing Address - Street 1:511 W MAIN ST
Mailing Address - Street 2:
Mailing Address - City:HOMER
Mailing Address - State:LA
Mailing Address - Zip Code:71040-3929
Mailing Address - Country:US
Mailing Address - Phone:318-927-3535
Mailing Address - Fax:318-927-9501
Practice Address - Street 1:511 W MAIN ST
Practice Address - Street 2:
Practice Address - City:HOMER
Practice Address - State:LA
Practice Address - Zip Code:71040-3929
Practice Address - Country:US
Practice Address - Phone:318-927-3535
Practice Address - Fax:318-927-9501
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-20
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA174-IR183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes183500000XPharmacy Service ProvidersPharmacistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1209198Medicaid
LA1209198Medicaid