Provider Demographics
NPI:1770925844
Name:WALTON, MARK HOWARD III (RPH, MS)
Entity type:Individual
Prefix:MR
First Name:MARK
Middle Name:HOWARD
Last Name:WALTON
Suffix:III
Gender:M
Credentials:RPH, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12341 OAKWIND PLACE
Mailing Address - Street 2:
Mailing Address - City:SEMINOLE
Mailing Address - State:FL
Mailing Address - Zip Code:33772
Mailing Address - Country:US
Mailing Address - Phone:727-460-5979
Mailing Address - Fax:
Practice Address - Street 1:12341 OAKWIND PL
Practice Address - Street 2:
Practice Address - City:SEMINOLE
Practice Address - State:FL
Practice Address - Zip Code:33772-2010
Practice Address - Country:US
Practice Address - Phone:727-460-5979
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-07-18
Last Update Date:2013-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS22985183500000X
MSPO6087183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist