Provider Demographics
NPI:1295281459
Name:POWELL, WALTER WILLIAM (RPH)
Entity type:Individual
Prefix:MR
First Name:WALTER
Middle Name:WILLIAM
Last Name:POWELL
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 1:8411 BROECKER BLVD
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40241-6101
Mailing Address - Country:US
Mailing Address - Phone:502-681-8442
Mailing Address - Fax:
Practice Address - Street 1:8411 BROECKER BLVD
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40241-6101
Practice Address - Country:US
Practice Address - Phone:502-681-8442
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-08-28
Last Update Date:2016-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY009014183500000X
GARPH019346183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist