Provider Demographics
NPI:1528382405
Name:WALKER, JUAN RODERICK (PHARMACIST)
Entity Type:Individual
Prefix:DR
First Name:JUAN
Middle Name:RODERICK
Last Name:WALKER
Suffix:
Gender:M
Credentials:PHARMACIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:438 W BREVARD ST
Mailing Address - Street 2:SUITE 11
Mailing Address - City:TALLAHASSEE
Mailing Address - State:FL
Mailing Address - Zip Code:32301-1004
Mailing Address - Country:US
Mailing Address - Phone:850-412-5490
Mailing Address - Fax:
Practice Address - Street 1:438 W BREVARD ST
Practice Address - Street 2:SUITE 11
Practice Address - City:TALLAHASSEE
Practice Address - State:FL
Practice Address - Zip Code:32301-1004
Practice Address - Country:US
Practice Address - Phone:850-412-5490
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-03-20
Last Update Date:2010-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS023564183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist