Provider Demographics
NPI:1649543430
Name:WALTER, GALEN SCOTT (RPH)
Entity type:Individual
Prefix:MR
First Name:GALEN
Middle Name:SCOTT
Last Name:WALTER
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 1:23324 E INLET DR
Mailing Address - Street 2:
Mailing Address - City:LIBERTY LAKE
Mailing Address - State:WA
Mailing Address - Zip Code:99019-9786
Mailing Address - Country:US
Mailing Address - Phone:509-255-9635
Mailing Address - Fax:
Practice Address - Street 1:23324 E INLET DR
Practice Address - Street 2:
Practice Address - City:LIBERTY LAKE
Practice Address - State:WA
Practice Address - Zip Code:99019-9786
Practice Address - Country:US
Practice Address - Phone:509-255-9635
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-02-10
Last Update Date:2012-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPH00011569183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAPH00011569OtherPHARMACIST LICENSE