Provider Demographics
NPI:1649410390
Name:WALROND, ESMOND
Entity Type:Individual
Prefix:
First Name:ESMOND
Middle Name:
Last Name:WALROND
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:ESMOND
Other - Middle Name:
Other - Last Name:WALDRON
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:4026 BOSTON RD # A
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10475-1122
Mailing Address - Country:US
Mailing Address - Phone:718-379-9000
Mailing Address - Fax:
Practice Address - Street 1:4026 BOSTON RD # A
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10475-1122
Practice Address - Country:US
Practice Address - Phone:718-379-9000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-02-20
Last Update Date:2009-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY30038183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist