Provider Demographics
NPI:1760101315
Name:WALLS, DENNISE (RPH)
Entity Type:Individual
Prefix:
First Name:DENNISE
Middle Name:
Last Name:WALLS
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:DENNISE
Other - Middle Name:
Other - Last Name:FERMIN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RPH
Mailing Address - Street 1:6855 ALIANTE PKWY
Mailing Address - Street 2:
Mailing Address - City:NORTH LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89084-3195
Mailing Address - Country:US
Mailing Address - Phone:702-642-6062
Mailing Address - Fax:
Practice Address - Street 1:6855 ALIANTE PKWY
Practice Address - Street 2:
Practice Address - City:NORTH LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89084-3195
Practice Address - Country:US
Practice Address - Phone:702-642-6062
Practice Address - Fax:702-642-0586
Is Sole Proprietor?:No
Enumeration Date:2022-08-25
Last Update Date:2022-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV15912183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist