Provider Demographics
NPI:1942363171
Name:WALTER, WILLIAM HENRY (RPH)
Entity Type:Individual
Prefix:MR
First Name:WILLIAM
Middle Name:HENRY
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 1:4377 TOMMY CT
Mailing Address - Street 2:
Mailing Address - City:RESCUE
Mailing Address - State:CA
Mailing Address - Zip Code:95672
Mailing Address - Country:US
Mailing Address - Phone:530-677-2930
Mailing Address - Fax:
Practice Address - Street 1:2210 SUNRISE BLVD
Practice Address - Street 2:PRICELESS DRUG STORE
Practice Address - City:RANCHO CORDOVA
Practice Address - State:CA
Practice Address - Zip Code:95670-4377
Practice Address - Country:US
Practice Address - Phone:916-638-0214
Practice Address - Fax:916-638-2513
Is Sole Proprietor?:No
Enumeration Date:2006-12-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CARPH29382183500000X
OR6043183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist