Provider Demographics
NPI:1275842791
Name:FLOYD, WALTER P (RPH)
Entity Type:Individual
Prefix:
First Name:WALTER
Middle Name:P
Last Name:FLOYD
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 1:1915 GRANGEWAY RD
Mailing Address - Street 2:
Mailing Address - City:MARSHALL
Mailing Address - State:TX
Mailing Address - Zip Code:75672-5129
Mailing Address - Country:US
Mailing Address - Phone:903-938-6069
Mailing Address - Fax:
Practice Address - Street 1:590 W MAIN ST
Practice Address - Street 2:
Practice Address - City:HALLSVILLE
Practice Address - State:TX
Practice Address - Zip Code:75650-5189
Practice Address - Country:US
Practice Address - Phone:903-668-1409
Practice Address - Fax:903-668-1320
Is Sole Proprietor?:No
Enumeration Date:2010-10-01
Last Update Date:2014-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX22334183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist