Provider Demographics
NPI:1538299359
Name:WALSH, MARY C
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:C
Last Name:WALSH
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:255 BERTOLET SCHOOL RD
Mailing Address - Street 2:
Mailing Address - City:SPRING CITY
Mailing Address - State:PA
Mailing Address - Zip Code:19475-3213
Mailing Address - Country:US
Mailing Address - Phone:610-469-2190
Mailing Address - Fax:610-469-2190
Practice Address - Street 1:1 MARCHWOOD RD
Practice Address - Street 2:
Practice Address - City:EXTON
Practice Address - State:PA
Practice Address - Zip Code:19341-1840
Practice Address - Country:US
Practice Address - Phone:610-363-9444
Practice Address - Fax:610-363-1966
Is Sole Proprietor?:No
Enumeration Date:2007-03-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARP033375L183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist