Healthcare Provider Details

I. General information

NPI: 1700972684
Provider Name (Legal Business Name): ROBERT RUSSELL WALSMAN RPH
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/05/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 E GEORGE ST
BATESVILLE IN
47006
US

IV. Provider business mailing address

PO BOX 221
BATESVILLE IN
47006
US

V. Phone/Fax

Practice location:
  • Phone: 812-934-2414
  • Fax: 812-934-3909
Mailing address:
  • Phone: 812-934-2754
  • Fax: 812-934-3909

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number26012567A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: