Healthcare Provider Details

I. General information

NPI: 1720374580
Provider Name (Legal Business Name): MRS. ROBYN JANE WALKER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/21/2011
Last Update Date: 06/21/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1251 JOHNSON AVE
SAN LUIS OBISPO CA
93401-3306
US

IV. Provider business mailing address

1251 JOHNSON AVE
SAN LUIS OBISPO CA
93401-3306
US

V. Phone/Fax

Practice location:
  • Phone: 805-545-0655
  • Fax: 805-545-8713
Mailing address:
  • Phone: 805-545-0655
  • Fax: 805-545-8713

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number54274
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: