Provider Demographics
NPI:1013632868
Name:WALLS, SONJA LYNNE
Entity Type:Individual
Prefix:
First Name:SONJA
Middle Name:LYNNE
Last Name:WALLS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:181 DAHLIA RD
Mailing Address - Street 2:
Mailing Address - City:HUNTSVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:77320-0746
Mailing Address - Country:US
Mailing Address - Phone:936-718-6614
Mailing Address - Fax:
Practice Address - Street 1:2421 SAM HOUSTON AVE
Practice Address - Street 2:
Practice Address - City:HUNTSVILLE
Practice Address - State:TX
Practice Address - Zip Code:77340-5862
Practice Address - Country:US
Practice Address - Phone:936-439-9038
Practice Address - Fax:936-436-9198
Is Sole Proprietor?:No
Enumeration Date:2022-10-04
Last Update Date:2022-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX32312183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist