Provider Demographics
NPI:1760854723
Name:WALKER, MONIQUE P
Entity Type:Individual
Prefix:
First Name:MONIQUE
Middle Name:P
Last Name:WALKER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:MONIQUE
Other - Middle Name:P
Other - Last Name:WALKER
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PHARMD
Mailing Address - Street 1:4160 KALANI PL
Mailing Address - Street 2:
Mailing Address - City:PRINCEVILLE
Mailing Address - State:HI
Mailing Address - Zip Code:96722-5427
Mailing Address - Country:US
Mailing Address - Phone:714-306-1544
Mailing Address - Fax:
Practice Address - Street 1:4469 WAIALO RD
Practice Address - Street 2:
Practice Address - City:ELEELE
Practice Address - State:HI
Practice Address - Zip Code:96705
Practice Address - Country:US
Practice Address - Phone:808-335-0700
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-10-29
Last Update Date:2021-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA61420183500000X
HI4543183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist