Provider Demographics
NPI:1457451965
Name:WALTON, BARRY (DPH)
Entity Type:Individual
Prefix:DR
First Name:BARRY
Middle Name:
Last Name:WALTON
Suffix:
Gender:M
Credentials:DPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2117 SWANNANOA AVE
Mailing Address - Street 2:
Mailing Address - City:KINGSPORT
Mailing Address - State:TN
Mailing Address - Zip Code:37664-3222
Mailing Address - Country:US
Mailing Address - Phone:423-765-7787
Mailing Address - Fax:423-245-7261
Practice Address - Street 1:1455 E CENTER ST
Practice Address - Street 2:
Practice Address - City:KINGSPORT
Practice Address - State:TN
Practice Address - Zip Code:37664-2501
Practice Address - Country:US
Practice Address - Phone:423-245-2181
Practice Address - Fax:423-245-7261
Is Sole Proprietor?:No
Enumeration Date:2006-09-24
Last Update Date:2024-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN7519183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN7519OtherSTATE PHARMACISTS LICENSE