Provider Demographics
NPI:1942086285
Name:WALKER, NADINE EUGENIE (PHARMACIST)
Entity Type:Individual
Prefix:
First Name:NADINE
Middle Name:EUGENIE
Last Name:WALKER
Suffix:
Gender:F
Credentials:PHARMACIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1922 SE BURGUNDY LN
Mailing Address - Street 2:
Mailing Address - City:PORT ST LUCIE
Mailing Address - State:FL
Mailing Address - Zip Code:34952-8866
Mailing Address - Country:US
Mailing Address - Phone:561-530-9983
Mailing Address - Fax:
Practice Address - Street 1:8701 S US HIGHWAY 1
Practice Address - Street 2:
Practice Address - City:PORT ST LUCIE
Practice Address - State:FL
Practice Address - Zip Code:34952-3333
Practice Address - Country:US
Practice Address - Phone:772-301-1095
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-09-04
Last Update Date:2023-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS66185183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist