Provider Demographics
NPI:1568989937
Name:WALKER, NEVIN P (RPH)
Entity Type:Individual
Prefix:
First Name:NEVIN
Middle Name:P
Last Name:WALKER
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:509 4TH AVE
Mailing Address - Street 2:
Mailing Address - City:ROCK FALLS
Mailing Address - State:IL
Mailing Address - Zip Code:61071-1248
Mailing Address - Country:US
Mailing Address - Phone:815-631-4744
Mailing Address - Fax:
Practice Address - Street 1:2506 E LINCOLNWAY
Practice Address - Street 2:
Practice Address - City:STERLING
Practice Address - State:IL
Practice Address - Zip Code:61081-3052
Practice Address - Country:US
Practice Address - Phone:815-626-4920
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-08-27
Last Update Date:2017-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL051.300380183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist