Provider Demographics
NPI:1982295093
Name:WALKER, CHERYL BOEHM (RPH)
Entity Type:Individual
Prefix:
First Name:CHERYL
Middle Name:BOEHM
Last Name:WALKER
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:53302 HICKORY RD
Mailing Address - Street 2:
Mailing Address - City:SOUTH BEND
Mailing Address - State:IN
Mailing Address - Zip Code:46635-1440
Mailing Address - Country:US
Mailing Address - Phone:574-329-6568
Mailing Address - Fax:
Practice Address - Street 1:120 INDIAN RIDGE BLVD
Practice Address - Street 2:
Practice Address - City:MISHAWAKA
Practice Address - State:IN
Practice Address - Zip Code:46545-9033
Practice Address - Country:US
Practice Address - Phone:574-243-8419
Practice Address - Fax:574-243-8521
Is Sole Proprietor?:Yes
Enumeration Date:2021-02-01
Last Update Date:2021-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN26013448A183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist