Provider Demographics
NPI:1639589500
Name:VANWINKLE, WALTER RICHARD (RPH)
Entity Type:Individual
Prefix:MR
First Name:WALTER
Middle Name:RICHARD
Last Name:VANWINKLE
Suffix:
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 1:800 S US HIGHWAY 131
Mailing Address - Street 2:
Mailing Address - City:THREE RIVERS
Mailing Address - State:MI
Mailing Address - Zip Code:49093-8819
Mailing Address - Country:US
Mailing Address - Phone:269-279-1200
Mailing Address - Fax:269-279-1235
Practice Address - Street 1:800 S US HIGHWAY 131
Practice Address - Street 2:
Practice Address - City:THREE RIVERS
Practice Address - State:MI
Practice Address - Zip Code:49093-8819
Practice Address - Country:US
Practice Address - Phone:269-279-1200
Practice Address - Fax:269-279-1235
Is Sole Proprietor?:Yes
Enumeration Date:2014-05-01
Last Update Date:2014-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5302 4109421835P1200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P1200XPharmacy Service ProvidersPharmacistPharmacotherapy
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI5302 410942OtherSTATE OF MICHIGAN PHARMACY LICENSE