Provider Demographics
NPI:1891463659
Name:WALNUT PHARMACY LLC
Entity Type:Organization
Organization Name:WALNUT PHARMACY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:CHANDRA
Authorized Official - Middle Name:
Authorized Official - Last Name:KADIYALA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:509-392-1958
Mailing Address - Street 1:10331 W GOSHEN AVE UNIT B
Mailing Address - Street 2:
Mailing Address - City:VISALIA
Mailing Address - State:CA
Mailing Address - Zip Code:93291-8778
Mailing Address - Country:US
Mailing Address - Phone:559-553-9145
Mailing Address - Fax:559-369-2408
Practice Address - Street 1:10331 W GOSHEN AVE UNIT B
Practice Address - Street 2:
Practice Address - City:VISALIA
Practice Address - State:CA
Practice Address - Zip Code:93291-8778
Practice Address - Country:US
Practice Address - Phone:559-553-9145
Practice Address - Fax:559-369-2408
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-09-05
Last Update Date:2024-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336L0003XSuppliersPharmacyLong Term Care Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA58331OtherPHARMACY LICENSE