Healthcare Provider Details

I. General information

NPI: 1164879482
Provider Name (Legal Business Name): WALTER PUTNAM PHARM D
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/17/2016
Last Update Date: 03/11/2022
Certification Date: 03/11/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1021 E PALMDALE ST STE 150-P
TUCSON AZ
85714-1857
US

IV. Provider business mailing address

1460 N DORADO BLVD
TUCSON AZ
85715-4708
US

V. Phone/Fax

Practice location:
  • Phone: 520-399-8279
  • Fax:
Mailing address:
  • Phone: 520-390-3944
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberS021981
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: