Provider Demographics
NPI:1891018164
Name:WALTER, JENNY MARIE (PHARMD)
Entity type:Individual
Prefix:
First Name:JENNY
Middle Name:MARIE
Last Name:WALTER
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:JENNY
Other - Middle Name:MARIE
Other - Last Name:LEWIS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3709 E 10TH ST
Mailing Address - Street 2:
Mailing Address - City:SIOUX FALLS
Mailing Address - State:SD
Mailing Address - Zip Code:57103-2113
Mailing Address - Country:US
Mailing Address - Phone:605-332-0102
Mailing Address - Fax:605-339-3617
Practice Address - Street 1:3709 E 10TH ST
Practice Address - Street 2:
Practice Address - City:SIOUX FALLS
Practice Address - State:SD
Practice Address - Zip Code:57103-2113
Practice Address - Country:US
Practice Address - Phone:605-332-0102
Practice Address - Fax:605-339-3617
Is Sole Proprietor?:No
Enumeration Date:2010-03-01
Last Update Date:2010-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SD5281183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist