Provider Demographics
NPI:1225463235
Name:WALLS, AMANDA DARLENE (PHARMD)
Entity Type:Individual
Prefix:
First Name:AMANDA
Middle Name:DARLENE
Last Name:WALLS
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10801 WESTHEIMER RD
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77042-3201
Mailing Address - Country:US
Mailing Address - Phone:713-580-0178
Mailing Address - Fax:
Practice Address - Street 1:10801 WESTHEIMER RD
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77042-3201
Practice Address - Country:US
Practice Address - Phone:713-580-0178
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-09-09
Last Update Date:2013-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX53947183500000X
VA0202212536183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist