Healthcare Provider Details

I. General information

NPI: 1306842679
Provider Name (Legal Business Name): VICTOR MCCOY WALKER JR. R.PH., B.C.P.P.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/22/2005
Last Update Date: 12/08/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

811 SHASTA CIR
EL DORADO HILLS CA
95762-4535
US

IV. Provider business mailing address

811 SHASTA CIR
EL DORADO HILLS CA
95762-4535
US

V. Phone/Fax

Practice location:
  • Phone: 916-933-2907
  • Fax:
Mailing address:
  • Phone: 916-933-2907
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1835P1300X
TaxonomyPsychiatric Pharmacist
License NumberRPH035999
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: