Provider Demographics
NPI:1417287574
Name:WALTERS, JENNY K (PHARMD)
Entity Type:Individual
Prefix:
First Name:JENNY
Middle Name:K
Last Name:WALTERS
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 1:8280 W LOWER BUCKEYE RD
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85043-7405
Mailing Address - Country:US
Mailing Address - Phone:623-936-6388
Mailing Address - Fax:623-936-9034
Practice Address - Street 1:8280 W LOWER BUCKEYE RD
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85043-7405
Practice Address - Country:US
Practice Address - Phone:623-936-6388
Practice Address - Fax:623-936-9034
Is Sole Proprietor?:No
Enumeration Date:2010-01-12
Last Update Date:2010-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZS015691183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist