Healthcare Provider Details

I. General information

NPI: 1477956183
Provider Name (Legal Business Name): JAMES WYATT WALKER RPH
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/08/2014
Last Update Date: 11/19/2020
Certification Date: 11/17/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3066 LOUISIANA HWY 78
LIVONIA LA
70755
US

IV. Provider business mailing address

5600 ISLAND RD
JARREAU LA
70749-3307
US

V. Phone/Fax

Practice location:
  • Phone: 225-637-2356
  • Fax: 225-637-2855
Mailing address:
  • Phone: 225-202-5699
  • Fax: 225-637-2855

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number8110
License Number StateLA
# 2
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number16690
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: