Provider Demographics
NPI:1023631843
Name:WALTER, ZACHARY ADAM (PHARMD)
Entity type:Individual
Prefix:DR
First Name:ZACHARY
Middle Name:ADAM
Last Name:WALTER
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:460 SW MT SI BLVD
Mailing Address - Street 2:
Mailing Address - City:NORTH BEND
Mailing Address - State:WA
Mailing Address - Zip Code:98045-8291
Mailing Address - Country:US
Mailing Address - Phone:425-831-2126
Mailing Address - Fax:
Practice Address - Street 1:460 SW MT SI BLVD
Practice Address - Street 2:
Practice Address - City:NORTH BEND
Practice Address - State:WA
Practice Address - Zip Code:98045-8291
Practice Address - Country:US
Practice Address - Phone:425-831-2126
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-05-27
Last Update Date:2020-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA61040748183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist