Provider Demographics
NPI:1134330863
Name:EAST, WALTER RAYMOND JR (RPH)
Entity Type:Individual
Prefix:MR
First Name:WALTER
Middle Name:RAYMOND
Last Name:EAST
Suffix:JR
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:500 DUSTY LN
Mailing Address - Street 2:
Mailing Address - City:LINWOOD
Mailing Address - State:NJ
Mailing Address - Zip Code:08221-1055
Mailing Address - Country:US
Mailing Address - Phone:609-927-5714
Mailing Address - Fax:609-625-5334
Practice Address - Street 1:4454 BLACK HORSE PIKE
Practice Address - Street 2:
Practice Address - City:MAYS LANDING
Practice Address - State:NJ
Practice Address - Zip Code:08330
Practice Address - Country:US
Practice Address - Phone:609-625-5012
Practice Address - Fax:609-625-5334
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJRI018718183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist