Provider Demographics
NPI:1952985913
Name:WALTON, D'AUVION TAYLOR
Entity Type:Individual
Prefix:
First Name:D'AUVION
Middle Name:TAYLOR
Last Name:WALTON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3350 E PRINCESS ANNE RD
Mailing Address - Street 2:
Mailing Address - City:NORFOLK
Mailing Address - State:VA
Mailing Address - Zip Code:23502-1564
Mailing Address - Country:US
Mailing Address - Phone:757-216-0649
Mailing Address - Fax:757-216-0650
Practice Address - Street 1:3350 E PRINCESS ANNE RD
Practice Address - Street 2:
Practice Address - City:NORFOLK
Practice Address - State:VA
Practice Address - Zip Code:23502-1564
Practice Address - Country:US
Practice Address - Phone:757-216-0649
Practice Address - Fax:757-216-0650
Is Sole Proprietor?:Yes
Enumeration Date:2021-05-06
Last Update Date:2021-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0230036832183700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183700000XPharmacy Service ProvidersPharmacy Technician