1013071265 NPI number — WALKER DRUG COMPANY, INC

Table of content: (NPI 1013071265)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1013071265 NPI number — WALKER DRUG COMPANY, INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
WALKER DRUG COMPANY, INC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
6
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1013071265
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/16/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
290 S MAIN ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MOAB
Provider Business Mailing Address State Name:
UT
Provider Business Mailing Address Postal Code:
84532-2509
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
435-259-5959
Provider Business Mailing Address Fax Number:
435-259-0174

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
290 S MAIN ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MOAB
Provider Business Practice Location Address State Name:
UT
Provider Business Practice Location Address Postal Code:
84532-2509
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
435-259-5959
Provider Business Practice Location Address Fax Number:
435-259-0174
Provider Enumeration Date:
12/21/2006

Additional Information

Authorized Official

Authorized Official Last Name:
HARRISON
Authorized Official First Name:
BENJAMIN
Authorized Official Middle Name:
Q
Authorized Official Title or Position:
PHARMACY MANAGER
Authorized Official Telephone Number:
435-259-5959

Provider Taxonomy Codes

  • Taxonomy code: 183500000X , with the licence number:  118802-1703 , registered in the state of UT ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 4601743 . This is a "NABP - NCPDP" identifier , issued by the state of ( UT ) . This identifiers is of the category "OTHER".




Copyright © 2007-2025 www.npivalidator.com