Provider Demographics
NPI:1407569791
Name:WALSH, IAN (PHARMD)
Entity Type:Individual
Prefix:
First Name:IAN
Middle Name:
Last Name:WALSH
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 1:460 PALISADES DR
Mailing Address - Street 2:
Mailing Address - City:LINCOLNTON
Mailing Address - State:NC
Mailing Address - Zip Code:28092-0026
Mailing Address - Country:US
Mailing Address - Phone:980-333-5169
Mailing Address - Fax:
Practice Address - Street 1:639 NUWAY CIR
Practice Address - Street 2:
Practice Address - City:LENOIR
Practice Address - State:NC
Practice Address - Zip Code:28645-3646
Practice Address - Country:US
Practice Address - Phone:828-759-7343
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-01-02
Last Update Date:2023-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC31268183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist