Provider Demographics
NPI:1679761191
Name:MAIKRANZ, WALTER VICTOR (RPH)
Entity Type:Individual
Prefix:MR
First Name:WALTER
Middle Name:VICTOR
Last Name:MAIKRANZ
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 1:6326 SALGE DR
Mailing Address - Street 2:
Mailing Address - City:FORT WAYNE
Mailing Address - State:IN
Mailing Address - Zip Code:46835-2460
Mailing Address - Country:US
Mailing Address - Phone:260-486-2557
Mailing Address - Fax:260-486-2557
Practice Address - Street 1:6326 SALGE DR
Practice Address - Street 2:
Practice Address - City:FORT WAYNE
Practice Address - State:IN
Practice Address - Zip Code:46835-2460
Practice Address - Country:US
Practice Address - Phone:260-486-2557
Practice Address - Fax:260-486-2557
Is Sole Proprietor?:No
Enumeration Date:2007-10-10
Last Update Date:2007-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN26014087183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist