Healthcare Provider Details

I. General information

NPI: 1184432957
Provider Name (Legal Business Name): AMY WALLER PHARMD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/24/2024
Last Update Date: 12/24/2024
Certification Date: 12/24/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1700 CENTER ST
MOBILE AL
36604-3301
US

IV. Provider business mailing address

6367 OAKLEIGH WAY
MOBILE AL
36693-3442
US

V. Phone/Fax

Practice location:
  • Phone: 251-415-1630
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number15857
License Number StateAL
# 2
Primary TaxonomyN
Taxonomy Code1835P0200X
TaxonomyPediatric Pharmacist
License Number15857
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: