Provider Demographics
NPI:1639463961
Name:WALTHER, ALICIA (PHARMD)
Entity Type:Individual
Prefix:
First Name:ALICIA
Middle Name:
Last Name:WALTHER
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4000 N 1ST AVE
Mailing Address - Street 2:
Mailing Address - City:EVANSVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:47710-3614
Mailing Address - Country:US
Mailing Address - Phone:812-428-2285
Mailing Address - Fax:812-428-2285
Practice Address - Street 1:4000 N 1ST AVE
Practice Address - Street 2:
Practice Address - City:EVANSVILLE
Practice Address - State:IN
Practice Address - Zip Code:47710-3614
Practice Address - Country:US
Practice Address - Phone:812-428-2285
Practice Address - Fax:812-428-2285
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-03
Last Update Date:2011-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN26022743A183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist