Healthcare Provider Details

I. General information

NPI: 1609819804
Provider Name (Legal Business Name): WALKER PHARMACY AND GIFTS, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/14/2006
Last Update Date: 03/07/2023
Certification Date: 02/23/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

102 PARKER AVE S
BROOKLET GA
30415-8208
US

IV. Provider business mailing address

PO BOX 215
BROOKLET GA
30415-0215
US

V. Phone/Fax

Practice location:
  • Phone: 912-842-9886
  • Fax: 912-842-9890
Mailing address:
  • Phone: 912-842-9886
  • Fax: 912-842-9890

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number9645
License Number StateGA

VIII. Authorized Official

Name: JORDAN DENT WALKER
Title or Position: PRESIDENT
Credential: PHARMD
Phone: 912-681-3784