Provider Demographics
NPI:1124534532
Name:WALTER, PATRICK J (RPH)
Entity Type:Individual
Prefix:
First Name:PATRICK
Middle Name:J
Last Name:WALTER
Suffix:
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 1:11333 AURORA AVE
Mailing Address - Street 2:
Mailing Address - City:URBANDALE
Mailing Address - State:IA
Mailing Address - Zip Code:50322-7908
Mailing Address - Country:US
Mailing Address - Phone:515-557-3235
Mailing Address - Fax:515-557-3125
Practice Address - Street 1:11333 AURORA AVE
Practice Address - Street 2:
Practice Address - City:URBANDALE
Practice Address - State:IA
Practice Address - Zip Code:50322-7908
Practice Address - Country:US
Practice Address - Phone:515-557-3235
Practice Address - Fax:515-557-3125
Is Sole Proprietor?:Yes
Enumeration Date:2017-12-20
Last Update Date:2017-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA164213336C0003X, 3336S0011X, 3336H0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336H0001XSuppliersPharmacyHome Infusion Therapy Pharmacy
No3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No3336S0011XSuppliersPharmacySpecialty Pharmacy