Provider Demographics
NPI:1033493416
Name:WALTERS, JEAN M (RPH)
Entity Type:Individual
Prefix:MS
First Name:JEAN
Middle Name:M
Last Name:WALTERS
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:27 COLONIAL WAY
Mailing Address - Street 2:
Mailing Address - City:FALMOUTH
Mailing Address - State:MA
Mailing Address - Zip Code:02540-4315
Mailing Address - Country:US
Mailing Address - Phone:508-540-6208
Mailing Address - Fax:
Practice Address - Street 1:1041 ROUTE 28
Practice Address - Street 2:
Practice Address - City:SOUTH YARMOUTH
Practice Address - State:MA
Practice Address - Zip Code:02664-4115
Practice Address - Country:US
Practice Address - Phone:508-394-1325
Practice Address - Fax:508-760-9717
Is Sole Proprietor?:No
Enumeration Date:2011-10-04
Last Update Date:2011-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MAPH16857183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAPH16857OtherBOARD OF PHARMACY PHARMACIST REGISTRATION