Provider Demographics
NPI:1588946487
Name:PATSAKHAM, TALYN LE (PHARMD)
Entity type:Individual
Prefix:
First Name:TALYN
Middle Name:LE
Last Name:PATSAKHAM
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5296 JIMMY CARTER BLVD
Mailing Address - Street 2:
Mailing Address - City:NORCROSS
Mailing Address - State:GA
Mailing Address - Zip Code:30093-1603
Mailing Address - Country:US
Mailing Address - Phone:770-798-9355
Mailing Address - Fax:863-859-2710
Practice Address - Street 1:5296 JIMMY CARTER BLVD
Practice Address - Street 2:
Practice Address - City:NORCROSS
Practice Address - State:GA
Practice Address - Zip Code:30093-1603
Practice Address - Country:US
Practice Address - Phone:770-798-9355
Practice Address - Fax:770-798-9975
Is Sole Proprietor?:No
Enumeration Date:2011-09-15
Last Update Date:2022-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS 43186183500000X
GARPH027652183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist