Healthcare Provider Details

I. General information

NPI: 1598777328
Provider Name (Legal Business Name): WALDEN R SMITH JR. PHARM.D
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/12/2006
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

800 ZORN AVE
LOUISVILLE KY
40206-1433
US

IV. Provider business mailing address

7500 NICOLE CT
LOUISVILLE KY
40220-5705
US

V. Phone/Fax

Practice location:
  • Phone: 502-287-4594
  • Fax: 502-287-6967
Mailing address:
  • Phone: 502-491-7391
  • Fax: 502-287-6967

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number8405
License Number StateKY
# 2
Primary TaxonomyN
Taxonomy Code1835P1200X
TaxonomyPharmacotherapy Pharmacist
License Number8405
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: