Provider Demographics
NPI:1659659738
Name:WALKER, TIARA NICOLE (PHARM D)
Entity Type:Individual
Prefix:DR
First Name:TIARA
Middle Name:NICOLE
Last Name:WALKER
Suffix:
Gender:F
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 1:1320 COLONIAL AVE
Mailing Address - Street 2:
Mailing Address - City:NORFOLK
Mailing Address - State:VA
Mailing Address - Zip Code:23517-2014
Mailing Address - Country:US
Mailing Address - Phone:757-533-9360
Mailing Address - Fax:757-533-9370
Practice Address - Street 1:1320 COLONIAL AVE
Practice Address - Street 2:
Practice Address - City:NORFOLK
Practice Address - State:VA
Practice Address - Zip Code:23517-2014
Practice Address - Country:US
Practice Address - Phone:757-533-9360
Practice Address - Fax:757-533-9370
Is Sole Proprietor?:No
Enumeration Date:2011-07-24
Last Update Date:2011-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0202210727183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist