Healthcare Provider Details

I. General information

NPI: 1477293199
Provider Name (Legal Business Name): AMY WALKER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/30/2022
Last Update Date: 03/30/2022
Certification Date: 03/30/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4905 E IRLO BRONSON MEMORIAL HWY
SAINT CLOUD FL
34771-8724
US

IV. Provider business mailing address

4905 E IRLO BRONSON MEMORIAL HWY
SAINT CLOUD FL
34771-8724
US

V. Phone/Fax

Practice location:
  • Phone: 407-891-8371
  • Fax:
Mailing address:
  • Phone: 407-891-8371
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberPS63850
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: