Provider Demographics
NPI:1770360992
Name:WALTERS, AMY NICOLE (PHARMD)
Entity type:Individual
Prefix:
First Name:AMY
Middle Name:NICOLE
Last Name:WALTERS
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4451 S AMMONS ST UNIT 1-302
Mailing Address - Street 2:
Mailing Address - City:LITTLETON
Mailing Address - State:CO
Mailing Address - Zip Code:80123-5451
Mailing Address - Country:US
Mailing Address - Phone:720-878-4425
Mailing Address - Fax:
Practice Address - Street 1:1601 E 19TH AVE STE 4650
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80218-1253
Practice Address - Country:US
Practice Address - Phone:303-656-4656
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-09-11
Last Update Date:2023-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COPHA.00220421835P0018X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P0018XPharmacy Service ProvidersPharmacistPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist