Provider Demographics
NPI:1568920015
Name:WALKER, SIDANY (PHARMD)
Entity Type:Individual
Prefix:
First Name:SIDANY
Middle Name:
Last Name:WALKER
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:SIDANY
Other - Middle Name:
Other - Last Name:KUONG
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:5340 LOOKOUT PASS
Mailing Address - Street 2:
Mailing Address - City:WESLEY CHAPEL
Mailing Address - State:FL
Mailing Address - Zip Code:33544-5501
Mailing Address - Country:US
Mailing Address - Phone:267-825-4101
Mailing Address - Fax:
Practice Address - Street 1:327 COLONY BLVD
Practice Address - Street 2:
Practice Address - City:THE VILLAGES
Practice Address - State:FL
Practice Address - Zip Code:32162-6084
Practice Address - Country:US
Practice Address - Phone:352-391-1808
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-03-04
Last Update Date:2019-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS55483183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist