Provider Demographics
NPI:1962002105
Name:WALKER, STUART N (RPH)
Entity Type:Individual
Prefix:MR
First Name:STUART
Middle Name:N
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 1:404 WHITE OAK DR
Mailing Address - Street 2:
Mailing Address - City:EL DORADO SPRINGS
Mailing Address - State:MO
Mailing Address - Zip Code:64744-2600
Mailing Address - Country:US
Mailing Address - Phone:417-296-0759
Mailing Address - Fax:
Practice Address - Street 1:2250 LINCOLN AVE
Practice Address - Street 2:
Practice Address - City:NEVADA
Practice Address - State:MO
Practice Address - Zip Code:64772-4258
Practice Address - Country:US
Practice Address - Phone:417-667-3011
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-10-27
Last Update Date:2020-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO040888183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist