Provider Demographics
NPI:1881964575
Name:WALKER, EDWARD AYMER
Entity type:Individual
Prefix:
First Name:EDWARD
Middle Name:AYMER
Last Name:WALKER
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8 BAYBERRY LN
Mailing Address - Street 2:
Mailing Address - City:REDDING
Mailing Address - State:CT
Mailing Address - Zip Code:06896-1828
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:8 BAYBERRY LN
Practice Address - Street 2:
Practice Address - City:REDDING
Practice Address - State:CT
Practice Address - Zip Code:06896-1828
Practice Address - Country:US
Practice Address - Phone:203-374-2819
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-01-11
Last Update Date:2012-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CTPCT.0000564183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist