1285056515 NPI number — WALKERS PHARMACY OF NEWTON INC

Table of content: (NPI 1285056515)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1285056515 NPI number — WALKERS PHARMACY OF NEWTON INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
WALKERS PHARMACY OF NEWTON 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:
1285056515
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/22/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 127
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
NEWTON
Provider Business Mailing Address State Name:
NC
Provider Business Mailing Address Postal Code:
28658-0127
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
828-464-1240
Provider Business Mailing Address Fax Number:
828-464-1218

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
33 N COLLEGE AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
NEWTON
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
28658-3235
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
828-464-1240
Provider Business Practice Location Address Fax Number:
828-464-1218
Provider Enumeration Date:
01/06/2014

Additional Information

Authorized Official

Authorized Official Last Name:
ALLEN
Authorized Official First Name:
WILLIAM
Authorized Official Middle Name:
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
828-464-1222

Provider Taxonomy Codes

  • Taxonomy code: 333600000X , with the licence number:  11785 , registered in the state of NC ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 2144399 . This is a "PK" identifier . This identifiers is of the category "OTHER".




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