Provider Demographics
NPI:1972868545
Name:WALTERS PHARMACY
Entity Type:Organization
Organization Name:WALTERS PHARMACY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CO-OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DANIEL
Authorized Official - Middle Name:
Authorized Official - Last Name:JONES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:270-753-7688
Mailing Address - Street 1:604 S 12TH ST
Mailing Address - Street 2:
Mailing Address - City:MURRAY
Mailing Address - State:KY
Mailing Address - Zip Code:42071-2916
Mailing Address - Country:US
Mailing Address - Phone:270-753-7688
Mailing Address - Fax:270-753-6782
Practice Address - Street 1:604 S 12TH ST
Practice Address - Street 2:
Practice Address - City:MURRAY
Practice Address - State:KY
Practice Address - Zip Code:42071-2916
Practice Address - Country:US
Practice Address - Phone:270-753-7688
Practice Address - Fax:270-753-6782
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:O J PHARMACY INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2012-07-10
Last Update Date:2012-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYP07513332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies