Provider Demographics
NPI:1598188435
Name:WALNECK, VIRGINIA (RPH)
Entity Type:Individual
Prefix:
First Name:VIRGINIA
Middle Name:
Last Name:WALNECK
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 1:302 W 5TH ST
Mailing Address - Street 2:
Mailing Address - City:SAFFORD
Mailing Address - State:AZ
Mailing Address - Zip Code:85546-2326
Mailing Address - Country:US
Mailing Address - Phone:928-428-3373
Mailing Address - Fax:928-428-0238
Practice Address - Street 1:755 S 20TH AVE
Practice Address - Street 2:
Practice Address - City:SAFFORD
Practice Address - State:AZ
Practice Address - Zip Code:85546-3322
Practice Address - Country:US
Practice Address - Phone:928-428-2291
Practice Address - Fax:928-428-0238
Is Sole Proprietor?:No
Enumeration Date:2014-01-29
Last Update Date:2014-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZS006613183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist