Provider Demographics
NPI:1598013062
Name:WALL, ANTHONY S (PHARM D)
Entity Type:Individual
Prefix:
First Name:ANTHONY
Middle Name:S
Last Name:WALL
Suffix:
Gender:M
Credentials:PHARM D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2821 DAHLIA ST
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80207-3054
Mailing Address - Country:US
Mailing Address - Phone:303-296-1893
Mailing Address - Fax:
Practice Address - Street 1:7311 E 29TH DR
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80238-2964
Practice Address - Country:US
Practice Address - Phone:720-214-5332
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-08-15
Last Update Date:2012-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO17509183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist