Healthcare Provider Details

I. General information

NPI: 1720631419
Provider Name (Legal Business Name): ERICA WALKER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/22/2019
Last Update Date: 07/22/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

214 MORRISON RD
BRANDON FL
33511-4849
US

IV. Provider business mailing address

1 TAMPA GENERAL CIR FL 2
TAMPA FL
33606-3571
US

V. Phone/Fax

Practice location:
  • Phone: 813-660-6846
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1835P2201X
TaxonomyAmbulatory Care Pharmacist
License NumberPS54910
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: