Provider Demographics
NPI:1598047771
Name:WALTON, DEBBIE JEAN (RPH)
Entity Type:Individual
Prefix:
First Name:DEBBIE
Middle Name:JEAN
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 1:270 W LAKE ST
Mailing Address - Street 2:
Mailing Address - City:BLOOMINGDALE
Mailing Address - State:IL
Mailing Address - Zip Code:60108-1038
Mailing Address - Country:US
Mailing Address - Phone:630-295-8876
Mailing Address - Fax:
Practice Address - Street 1:270 W LAKE ST
Practice Address - Street 2:
Practice Address - City:BLOOMINGDALE
Practice Address - State:IL
Practice Address - Zip Code:60108-1038
Practice Address - Country:US
Practice Address - Phone:630-295-8876
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-09-14
Last Update Date:2011-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL051-039811183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist