Healthcare Provider Details

I. General information

NPI: 1720074180
Provider Name (Legal Business Name): CHARLES MATTHEW WALKER PHARMD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/21/2005
Last Update Date: 04/24/2025
Certification Date: 04/24/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

490 M ST SW APT W105
WASHINGTON DC
20024-2636
US

IV. Provider business mailing address

490 M ST SW APT W105
WASHINGTON DC
20024-2636
US

V. Phone/Fax

Practice location:
  • Phone: 202-826-6288
  • Fax:
Mailing address:
  • Phone: 202-826-6288
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberPH100001382
License Number StateDC
# 2
Primary TaxonomyN
Taxonomy Code183500000X
TaxonomyPharmacist
License Number20970
License Number StateMD
# 3
Primary TaxonomyN
Taxonomy Code183500000X
TaxonomyPharmacist
License Number22955
License Number StateNC
# 4
Primary TaxonomyN
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberRPH022566
License Number StateGA
# 5
Primary TaxonomyN
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberA1-0016082
License Number StateDE
# 6
Primary TaxonomyN
Taxonomy Code1835P0018X
TaxonomyPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
License Number0202210401
License Number StateVA
# 7
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number011178
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: