Healthcare Provider Details

I. General information

NPI: 1205324910
Provider Name (Legal Business Name): DONNA MARIE WALSH PHARM.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/27/2018
Last Update Date: 04/27/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4755 OGLETOWN STANTON RD OFC LE15
NEWARK DE
19718-2200
US

IV. Provider business mailing address

4755 OGLETOWN STANTON RD
NEWARK DE
19718-2200
US

V. Phone/Fax

Practice location:
  • Phone: 302-733-6364
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code183500000X
TaxonomyPharmacist
License Number28RI03017700
License Number StateNJ
# 2
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberA1-0003661
License Number StateDE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: