Provider Demographics
NPI:1508158080
Name:WALKER, BRENDA T (RPH)
Entity Type:Individual
Prefix:
First Name:BRENDA
Middle Name:T
Last Name:WALKER
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4000 CENTRAL FLORIDA BLVD
Mailing Address - Street 2:BUILDING 127 RM 108
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32816-8005
Mailing Address - Country:US
Mailing Address - Phone:407-823-6337
Mailing Address - Fax:
Practice Address - Street 1:4000 CENTRAL FLORIDA BLVD
Practice Address - Street 2:BUILDING 127 RM 108
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32816-8005
Practice Address - Country:US
Practice Address - Phone:407-823-6337
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-05-03
Last Update Date:2011-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL27214183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist