Provider Demographics
NPI:1497359087
Name:WALKER, THOMAS DEAN (PD)
Entity Type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:DEAN
Last Name:WALKER
Suffix:
Gender:M
Credentials:PD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3035 SEQUOYAH DR
Mailing Address - Street 2:
Mailing Address - City:ROGERS
Mailing Address - State:AR
Mailing Address - Zip Code:72758-0253
Mailing Address - Country:US
Mailing Address - Phone:479-633-2116
Mailing Address - Fax:
Practice Address - Street 1:406 S WALTON BLVD
Practice Address - Street 2:
Practice Address - City:BENTONVILLE
Practice Address - State:AR
Practice Address - Zip Code:72712-5705
Practice Address - Country:US
Practice Address - Phone:479-273-5083
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-11-24
Last Update Date:2020-11-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARPD07456183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist