Healthcare Provider Details

I. General information

NPI: 1609847540
Provider Name (Legal Business Name): MICHAEL THOMAS WALDEN R.PH.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/30/2006
Last Update Date: 08/20/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

211 SUMMIT PKWY SUITE 112
HOMEWOOD AL
35209-4751
US

IV. Provider business mailing address

101 DREXAL DR
ONEONTA AL
35121-7075
US

V. Phone/Fax

Practice location:
  • Phone: 205-916-2267
  • Fax: 205-916-0877
Mailing address:
  • Phone: 205-559-3416
  • Fax: 205-625-5966

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1835P1200X
TaxonomyPharmacotherapy Pharmacist
License Number11062
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: