Provider Demographics
NPI:1679203970
Name:WALSH, KEITH (PHARMD)
Entity Type:Individual
Prefix:
First Name:KEITH
Middle Name:
Last Name:WALSH
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8441 N BOND ST
Mailing Address - Street 2:
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93720-2150
Mailing Address - Country:US
Mailing Address - Phone:559-917-1749
Mailing Address - Fax:
Practice Address - Street 1:785 N MEDICAL CENTER DR W STE 304
Practice Address - Street 2:
Practice Address - City:CLOVIS
Practice Address - State:CA
Practice Address - Zip Code:93611-6878
Practice Address - Country:US
Practice Address - Phone:559-387-1861
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-06-10
Last Update Date:2022-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA37371183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist