Provider Demographics
NPI:1073269726
Name:WALTERS, ROBBIE DEAN JR (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:ROBBIE
Middle Name:DEAN
Last Name:WALTERS
Suffix:JR
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:94 HERITAGE DR
Mailing Address - Street 2:
Mailing Address - City:CLOVER
Mailing Address - State:SC
Mailing Address - Zip Code:29710-9213
Mailing Address - Country:US
Mailing Address - Phone:803-448-5362
Mailing Address - Fax:
Practice Address - Street 1:94 HERITAGE DR
Practice Address - Street 2:
Practice Address - City:CLOVER
Practice Address - State:SC
Practice Address - Zip Code:29710-9213
Practice Address - Country:US
Practice Address - Phone:803-448-5362
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-02-22
Last Update Date:2022-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC28378183500000X
SC41994183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist