Provider Demographics
NPI:1619276649
Name:MOUSLEY, WALTER JAMES JR (RPH)
Entity Type:Individual
Prefix:MR
First Name:WALTER
Middle Name:JAMES
Last Name:MOUSLEY
Suffix:JR
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 1:801 N MARKET ST
Mailing Address - Street 2:
Mailing Address - City:WILMINGTON
Mailing Address - State:DE
Mailing Address - Zip Code:19801-3010
Mailing Address - Country:US
Mailing Address - Phone:302-655-7432
Mailing Address - Fax:
Practice Address - Street 1:801 N MARKET ST
Practice Address - Street 2:
Practice Address - City:WILMINGTON
Practice Address - State:DE
Practice Address - Zip Code:19801-3010
Practice Address - Country:US
Practice Address - Phone:302-655-7432
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-03-16
Last Update Date:2011-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEA1-0001790183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist