Healthcare Provider Details

I. General information

NPI: 1760854723
Provider Name (Legal Business Name): MONIQUE P WALKER
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: MONIQUE P WALKER PHARMD

II. Dates (important events)

Enumeration Date: 10/29/2015
Last Update Date: 01/08/2021
Certification Date: 12/31/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4469 WAIALO RD
ELEELE HI
96705
US

IV. Provider business mailing address

4160 KALANI PL
PRINCEVILLE HI
96722-5427
US

V. Phone/Fax

Practice location:
  • Phone: 808-335-0700
  • Fax:
Mailing address:
  • Phone: 714-306-1544
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code183500000X
TaxonomyPharmacist
License Number61420
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number4543
License Number StateHI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: