Provider Demographics
NPI:1518392034
Name:AGBOR, WALTER B (PHARM D,MS)
Entity Type:Individual
Prefix:
First Name:WALTER
Middle Name:B
Last Name:AGBOR
Suffix:
Gender:M
Credentials:PHARM D,MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2301 RUNNING HORSE RD
Mailing Address - Street 2:7573924934
Mailing Address - City:PLATTE CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64079-7703
Mailing Address - Country:US
Mailing Address - Phone:757-392-4934
Mailing Address - Fax:
Practice Address - Street 1:2301 RUNNING HORSE RD
Practice Address - Street 2:7573924934
Practice Address - City:PLATTE CITY
Practice Address - State:MO
Practice Address - Zip Code:64079-7703
Practice Address - Country:US
Practice Address - Phone:757-392-4934
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-09-04
Last Update Date:2014-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2013024736183500000X
KS116177183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist