Provider Demographics
NPI:1093389025
Name:WALTERS, DARRIN SCOTT (CPHT)
Entity Type:Individual
Prefix:MR
First Name:DARRIN
Middle Name:SCOTT
Last Name:WALTERS
Suffix:
Gender:M
Credentials:CPHT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7128 SEA PINE DR
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46250-4138
Mailing Address - Country:US
Mailing Address - Phone:317-828-7541
Mailing Address - Fax:
Practice Address - Street 1:5635 W 96TH ST
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46278-6011
Practice Address - Country:US
Practice Address - Phone:317-873-7484
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-05-14
Last Update Date:2021-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS14-107718183700000X
MN739511183700000X
IN67022512A183700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183700000XPharmacy Service ProvidersPharmacy Technician