Provider Demographics
NPI:1851692669
Name:WALTER, GREGORY J (RPH)
Entity Type:Individual
Prefix:MR
First Name:GREGORY
Middle Name:J
Last Name:WALTER
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 1:1052 E. SPRING ST.
Mailing Address - Street 2:
Mailing Address - City:ST. MARYS
Mailing Address - State:OH
Mailing Address - Zip Code:45885
Mailing Address - Country:US
Mailing Address - Phone:419-394-3219
Mailing Address - Fax:419-394-6289
Practice Address - Street 1:1052 E. SPRING ST.
Practice Address - Street 2:
Practice Address - City:ST. MARYS
Practice Address - State:OH
Practice Address - Zip Code:45885
Practice Address - Country:US
Practice Address - Phone:419-394-3219
Practice Address - Fax:419-394-6289
Is Sole Proprietor?:No
Enumeration Date:2010-11-10
Last Update Date:2017-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH03223403183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist