Provider Demographics
NPI:1407170582
Name:WALKER, VANESSA (RPH)
Entity Type:Individual
Prefix:MRS
First Name:VANESSA
Middle Name:
Last Name:WALKER
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:MRS
Other - First Name:VANESSA
Other - Middle Name:
Other - Last Name:LE SURE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:RPH
Mailing Address - Street 1:2109 NOSTRAND AVE
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11210-3001
Mailing Address - Country:US
Mailing Address - Phone:718-421-3600
Mailing Address - Fax:
Practice Address - Street 1:2109 NOSTRAND AVE
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11210-3001
Practice Address - Country:US
Practice Address - Phone:718-421-3600
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-03-18
Last Update Date:2019-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY041555183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist