Provider Demographics
NPI:1407131501
Name:WALKER, PAMELA BEA OLGA (RPH, PHARMD)
Entity Type:Individual
Prefix:
First Name:PAMELA
Middle Name:BEA OLGA
Last Name:WALKER
Suffix:
Gender:F
Credentials:RPH, PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:730 DREXEL ST
Mailing Address - Street 2:
Mailing Address - City:DEARBORN
Mailing Address - State:MI
Mailing Address - Zip Code:48128-1605
Mailing Address - Country:US
Mailing Address - Phone:313-561-5970
Mailing Address - Fax:
Practice Address - Street 1:17001 NEWBURGH RD # 10359
Practice Address - Street 2:
Practice Address - City:LIVONIA
Practice Address - State:MI
Practice Address - Zip Code:48154-1610
Practice Address - Country:US
Practice Address - Phone:734-462-1707
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-10-20
Last Update Date:2011-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5302038274183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist