Provider Demographics
NPI:1477956183
Name:WALKER, JAMES WYATT (RPH)
Entity type:Individual
Prefix:MR
First Name:JAMES
Middle Name:WYATT
Last Name:WALKER
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 1:5600 ISLAND RD
Mailing Address - Street 2:
Mailing Address - City:JARREAU
Mailing Address - State:LA
Mailing Address - Zip Code:70749-3307
Mailing Address - Country:US
Mailing Address - Phone:225-202-5699
Mailing Address - Fax:225-637-2855
Practice Address - Street 1:3066 LOUISIANA HWY 78
Practice Address - Street 2:
Practice Address - City:LIVONIA
Practice Address - State:LA
Practice Address - Zip Code:70755
Practice Address - Country:US
Practice Address - Phone:225-637-2356
Practice Address - Fax:225-637-2855
Is Sole Proprietor?:Yes
Enumeration Date:2014-10-08
Last Update Date:2020-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA81103336C0003X
LA16690183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
No3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA2207733Medicaid