Provider Demographics
NPI:1023020351
Name:WALKER, ROSWELL LINDSAY JR (RPH)
Entity Type:Individual
Prefix:MR
First Name:ROSWELL
Middle Name:LINDSAY
Last Name:WALKER
Suffix:JR
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 1:103 LANCASTER PT
Mailing Address - Street 2:
Mailing Address - City:STATESBORO
Mailing Address - State:GA
Mailing Address - Zip Code:30458-9049
Mailing Address - Country:US
Mailing Address - Phone:912-489-4073
Mailing Address - Fax:912-489-4649
Practice Address - Street 1:202 NORTHSIDE DR W
Practice Address - Street 2:
Practice Address - City:STATESBORO
Practice Address - State:GA
Practice Address - Zip Code:30458-5300
Practice Address - Country:US
Practice Address - Phone:912-764-6175
Practice Address - Fax:912-489-4649
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA13897183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA13897OtherSTATE NUMBER