Provider Demographics
NPI:1790078715
Name:WALLS, ADRIANNE (PHARM D)
Entity Type:Individual
Prefix:MS
First Name:ADRIANNE
Middle Name:
Last Name:WALLS
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 1:4417 BAY VIEW DR
Mailing Address - Street 2:
Mailing Address - City:MARRERO
Mailing Address - State:LA
Mailing Address - Zip Code:70072-6078
Mailing Address - Country:US
Mailing Address - Phone:832-314-7069
Mailing Address - Fax:
Practice Address - Street 1:1501 MANHATTAN BLVD
Practice Address - Street 2:
Practice Address - City:HARVEY
Practice Address - State:LA
Practice Address - Zip Code:70058-3405
Practice Address - Country:US
Practice Address - Phone:504-366-3358
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-05-24
Last Update Date:2014-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA020138183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist