Provider Demographics
NPI:1871860668
Name:WALKER, PATRICK WADE (RPH)
Entity Type:Individual
Prefix:
First Name:PATRICK
Middle Name:WADE
Last Name:WALKER
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 1:1100 HIGHWAY 51
Mailing Address - Street 2:
Mailing Address - City:MADISON
Mailing Address - State:MS
Mailing Address - Zip Code:39110-9088
Mailing Address - Country:US
Mailing Address - Phone:601-853-2088
Mailing Address - Fax:601-853-7408
Practice Address - Street 1:1100 HIGHWAY 51
Practice Address - Street 2:
Practice Address - City:MADISON
Practice Address - State:MS
Practice Address - Zip Code:39110-9088
Practice Address - Country:US
Practice Address - Phone:601-853-2088
Practice Address - Fax:601-853-7408
Is Sole Proprietor?:No
Enumeration Date:2011-11-21
Last Update Date:2011-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSE-09005183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist