Provider Demographics
NPI:1538463039
Name:WALTON, CHERYL L (RPH)
Entity Type:Individual
Prefix:
First Name:CHERYL
Middle Name:L
Last Name:WALTON
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 1:1400 W MAIN ST
Mailing Address - Street 2:
Mailing Address - City:JEFFERSONVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:19403-3226
Mailing Address - Country:US
Mailing Address - Phone:610-277-9812
Mailing Address - Fax:610-277-9817
Practice Address - Street 1:1400 W MAIN ST
Practice Address - Street 2:
Practice Address - City:JEFFERSONVILLE
Practice Address - State:PA
Practice Address - Zip Code:19403-3226
Practice Address - Country:US
Practice Address - Phone:610-277-9812
Practice Address - Fax:610-277-9817
Is Sole Proprietor?:Yes
Enumeration Date:2010-12-27
Last Update Date:2010-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPR037462L183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist