Provider Demographics
NPI:1558583260
Name:WALTON, REBECCA JAMES (RPH)
Entity Type:Individual
Prefix:MRS
First Name:REBECCA
Middle Name:JAMES
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 1:129 OLD HIGHWAY 431 STE C
Mailing Address - Street 2:
Mailing Address - City:HAMPTON COVE
Mailing Address - State:AL
Mailing Address - Zip Code:35763-9240
Mailing Address - Country:US
Mailing Address - Phone:256-534-7455
Mailing Address - Fax:256-534-8227
Practice Address - Street 1:129 OLD HIGHWAY 431 STE C
Practice Address - Street 2:
Practice Address - City:HAMPTON COVE
Practice Address - State:AL
Practice Address - Zip Code:35763-9240
Practice Address - Country:US
Practice Address - Phone:256-534-7455
Practice Address - Fax:256-534-8227
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-03
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL11868183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL1000003461Medicaid