Provider Demographics
NPI:1467895797
Name:WALKER, WADE (RPH)
Entity Type:Individual
Prefix:
First Name:WADE
Middle Name:
Last Name:WALKER
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1001 THOMPSON ROAD
Mailing Address - Street 2:
Mailing Address - City:GRANBY
Mailing Address - State:CO
Mailing Address - Zip Code:80446-0619
Mailing Address - Country:US
Mailing Address - Phone:970-887-7150
Mailing Address - Fax:970-887-7151
Practice Address - Street 1:1001 THOMPSON ROAD
Practice Address - Street 2:
Practice Address - City:GRANBY
Practice Address - State:CO
Practice Address - Zip Code:80446-0619
Practice Address - Country:US
Practice Address - Phone:970-887-7150
Practice Address - Fax:970-887-7151
Is Sole Proprietor?:No
Enumeration Date:2013-04-17
Last Update Date:2013-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO16291183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist