Provider Demographics
NPI:1013071265
Name:WALKER DRUG COMPANY, INC
Entity Type:Organization
Organization Name:WALKER DRUG COMPANY, INC
Other - Org Name:WALKER DRUG
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PHARMACY MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:BENJAMIN
Authorized Official - Middle Name:Q
Authorized Official - Last Name:HARRISON
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:435-259-5959
Mailing Address - Street 1:290 S MAIN ST
Mailing Address - Street 2:
Mailing Address - City:MOAB
Mailing Address - State:UT
Mailing Address - Zip Code:84532-2509
Mailing Address - Country:US
Mailing Address - Phone:435-259-5959
Mailing Address - Fax:435-259-0174
Practice Address - Street 1:290 S MAIN ST
Practice Address - Street 2:
Practice Address - City:MOAB
Practice Address - State:UT
Practice Address - Zip Code:84532-2509
Practice Address - Country:US
Practice Address - Phone:435-259-5959
Practice Address - Fax:435-259-0174
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-21
Last Update Date:2008-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT118802-1703183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes183500000XPharmacy Service ProvidersPharmacistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT4601743OtherNABP - NCPDP
UT4601743OtherNABP - NCPDP
UT4601743Medicare UPIN
UT=========001Medicaid