Provider Demographics
NPI:1376022178
Name:WALKER, JUSTIN D (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:JUSTIN
Middle Name:D
Last Name:WALKER
Suffix:
Gender:M
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:PO BOX 1800
Mailing Address - Street 2:
Mailing Address - City:OCEANA
Mailing Address - State:WV
Mailing Address - Zip Code:24870-1800
Mailing Address - Country:US
Mailing Address - Phone:304-682-8289
Mailing Address - Fax:304-682-4070
Practice Address - Street 1:928B COOK PARKWAY
Practice Address - Street 2:
Practice Address - City:OCEANA
Practice Address - State:WV
Practice Address - Zip Code:24870
Practice Address - Country:US
Practice Address - Phone:304-682-8289
Practice Address - Fax:304-682-4070
Is Sole Proprietor?:No
Enumeration Date:2018-08-13
Last Update Date:2018-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WVRP0007771183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist