Provider Demographics
NPI:1659335693
Name:WALKER, CHARLES A (PHARM D)
Entity Type:Individual
Prefix:
First Name:CHARLES
Middle Name:A
Last Name:WALKER
Suffix:
Gender:M
Credentials:PHARM D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1460 NO CAMINO ALTO
Mailing Address - Street 2:
Mailing Address - City:VALLEJO
Mailing Address - State:CA
Mailing Address - Zip Code:94590
Mailing Address - Country:US
Mailing Address - Phone:707-643-8492
Mailing Address - Fax:707-643-8493
Practice Address - Street 1:1460 N CAMINO ALTO
Practice Address - Street 2:
Practice Address - City:VALLEJO
Practice Address - State:CA
Practice Address - Zip Code:94589-2567
Practice Address - Country:US
Practice Address - Phone:707-643-8492
Practice Address - Fax:707-643-8493
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-14
Last Update Date:2008-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA32316183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1241630001Medicare NSC