Provider Demographics
NPI:1629455399
Name:WALTERS, ANTOLEE
Entity Type:Individual
Prefix:
First Name:ANTOLEE
Middle Name:
Last Name:WALTERS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1010 W FLAGLER ST
Mailing Address - Street 2:T-2848
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33130-1032
Mailing Address - Country:US
Mailing Address - Phone:305-894-2938
Mailing Address - Fax:
Practice Address - Street 1:1010 W FLAGLER ST
Practice Address - Street 2:T-2848
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33130-1032
Practice Address - Country:US
Practice Address - Phone:305-894-2938
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-05-01
Last Update Date:2015-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS47384183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist