Provider Demographics
NPI:1811280357
Name:WALKER, RICHARD EDWARD (RPH)
Entity type:Individual
Prefix:
First Name:RICHARD
Middle Name:EDWARD
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 1:9 VAN ROO AVE
Mailing Address - Street 2:
Mailing Address - City:MERRICK
Mailing Address - State:NY
Mailing Address - Zip Code:11566-3111
Mailing Address - Country:US
Mailing Address - Phone:516-868-5636
Mailing Address - Fax:516-868-5636
Practice Address - Street 1:9 VAN ROO AVE
Practice Address - Street 2:
Practice Address - City:MERRICK
Practice Address - State:NY
Practice Address - Zip Code:11566-3111
Practice Address - Country:US
Practice Address - Phone:516-868-5636
Practice Address - Fax:516-868-5636
Is Sole Proprietor?:Yes
Enumeration Date:2011-05-17
Last Update Date:2011-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY29370183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist