Provider Demographics
NPI:1932481454
Name:BARRON, WALTER E (RPH)
Entity Type:Individual
Prefix:
First Name:WALTER
Middle Name:E
Last Name:BARRON
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 1:1010 MAPLE AVE
Mailing Address - Street 2:WALGREENS PHARMACY
Mailing Address - City:LISLE
Mailing Address - State:IL
Mailing Address - Zip Code:60532-2329
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1010 MAPLE AVE
Practice Address - Street 2:WALGREENS PHARMACY
Practice Address - City:LISLE
Practice Address - State:IL
Practice Address - Zip Code:60532-2329
Practice Address - Country:US
Practice Address - Phone:630-353-0252
Practice Address - Fax:630-512-0409
Is Sole Proprietor?:Yes
Enumeration Date:2011-09-10
Last Update Date:2011-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL051-034505183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist