Provider Demographics
NPI:1932238714
Name:WALKER PHARMACY INC
Entity Type:Organization
Organization Name:WALKER PHARMACY INC
Other - Org Name:WALKER PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT AND PHARM IN CHARGE
Authorized Official - Prefix:
Authorized Official - First Name:LARRY
Authorized Official - Middle Name:
Authorized Official - Last Name:WALKER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:308-235-2361
Mailing Address - Street 1:129 S CHESTNUT ST
Mailing Address - Street 2:
Mailing Address - City:KIMBALL
Mailing Address - State:NE
Mailing Address - Zip Code:69145-1256
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:129 S CHESTNUT ST
Practice Address - Street 2:
Practice Address - City:KIMBALL
Practice Address - State:NE
Practice Address - Zip Code:69145-1256
Practice Address - Country:US
Practice Address - Phone:308-235-2361
Practice Address - Fax:308-235-2950
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-05
Last Update Date:2008-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE14133336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2802886OtherOTHER ID NUMBER
WY102722100Medicaid
NE=========00Medicaid