Provider Demographics
NPI:1386708733
Name:TALLEY, LARRY EUGENE (RPH)
Entity type:Individual
Prefix:MR
First Name:LARRY
Middle Name:EUGENE
Last Name:TALLEY
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3618 N DIXIELAND RD
Mailing Address - Street 2:
Mailing Address - City:ROGERS
Mailing Address - State:AR
Mailing Address - Zip Code:72756-7002
Mailing Address - Country:US
Mailing Address - Phone:479-936-7586
Mailing Address - Fax:
Practice Address - Street 1:991 W CENTERTON BLVD
Practice Address - Street 2:
Practice Address - City:CENTERTON
Practice Address - State:AR
Practice Address - Zip Code:72719-8707
Practice Address - Country:US
Practice Address - Phone:479-795-8199
Practice Address - Fax:479-795-8196
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARPD08774183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist