Provider Demographics
NPI:1609847540
Name:WALDEN, MICHAEL THOMAS (RPH)
Entity Type:Individual
Prefix:MR
First Name:MICHAEL
Middle Name:THOMAS
Last Name:WALDEN
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:101 DREXAL DR
Mailing Address - Street 2:
Mailing Address - City:ONEONTA
Mailing Address - State:AL
Mailing Address - Zip Code:35121-7075
Mailing Address - Country:US
Mailing Address - Phone:205-559-3416
Mailing Address - Fax:205-625-5966
Practice Address - Street 1:211 SUMMIT PKWY
Practice Address - Street 2:SUITE 112
Practice Address - City:HOMEWOOD
Practice Address - State:AL
Practice Address - Zip Code:35209-4751
Practice Address - Country:US
Practice Address - Phone:205-916-2267
Practice Address - Fax:205-916-0877
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-30
Last Update Date:2012-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL110621835P1200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P1200XPharmacy Service ProvidersPharmacistPharmacotherapy