Provider Demographics
NPI:1073113288
Name:WALTON, CARLA SUE
Entity Type:Individual
Prefix:
First Name:CARLA
Middle Name:SUE
Last Name:WALTON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:401 LINWOOD PLZ
Mailing Address - Street 2:
Mailing Address - City:LINDSAY
Mailing Address - State:OK
Mailing Address - Zip Code:73052-4602
Mailing Address - Country:US
Mailing Address - Phone:405-756-9591
Mailing Address - Fax:405-756-8611
Practice Address - Street 1:401 LINWOOD PLZ
Practice Address - Street 2:
Practice Address - City:LINDSAY
Practice Address - State:OK
Practice Address - Zip Code:73052-4602
Practice Address - Country:US
Practice Address - Phone:405-756-9591
Practice Address - Fax:405-756-8611
Is Sole Proprietor?:Yes
Enumeration Date:2020-10-27
Last Update Date:2020-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX31857183500000X
OK11813183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist