Provider Demographics
NPI:1124561782
Name:BRAINARD, WALKER (PHARM D)
Entity Type:Individual
Prefix:
First Name:WALKER
Middle Name:
Last Name:BRAINARD
Suffix:
Gender:M
Credentials:PHARM D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:101 ENGLEWOOD PKWY
Mailing Address - Street 2:
Mailing Address - City:ENGLEWOOD
Mailing Address - State:CO
Mailing Address - Zip Code:80110-2427
Mailing Address - Country:US
Mailing Address - Phone:303-761-0013
Mailing Address - Fax:
Practice Address - Street 1:101 ENGLEWOOD PKWY
Practice Address - Street 2:
Practice Address - City:ENGLEWOOD
Practice Address - State:CO
Practice Address - Zip Code:80110-2427
Practice Address - Country:US
Practice Address - Phone:303-761-0013
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-11-29
Last Update Date:2016-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK17025183500000X
COPHA - 21533183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist