Provider Demographics
NPI:1770650426
Name:L.D. WALTER GROUP
Entity type:Organization
Organization Name:L.D. WALTER GROUP
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PHARMACIST IN CHARGE
Authorized Official - Prefix:
Authorized Official - First Name:LARONDA
Authorized Official - Middle Name:
Authorized Official - Last Name:WALTER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:713-330-8011
Mailing Address - Street 1:507 N SAM HOUSTON PKWY E STE 430
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77060-4039
Mailing Address - Country:US
Mailing Address - Phone:713-330-8011
Mailing Address - Fax:713-330-3011
Practice Address - Street 1:507 N SAM HOUSTON PKWY E STE 430
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77060-4039
Practice Address - Country:US
Practice Address - Phone:713-330-8011
Practice Address - Fax:713-330-3011
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-29
Last Update Date:2024-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
3336C0003X
TX29715333600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy
No3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX149649Medicaid
2155063OtherPK