Healthcare Provider Details

I. General information

NPI: 1578646519
Provider Name (Legal Business Name): WALDEN ASSOCIATES INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/23/2006
Last Update Date: 05/20/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

106 E MAIN ST
BOONVILLE NC
27011-8764
US

IV. Provider business mailing address

PO BOX 10
BOONVILLE NC
27011-0010
US

V. Phone/Fax

Practice location:
  • Phone: 336-367-5333
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number04148
License Number StateNC
# 3
Primary TaxonomyN
Taxonomy Code3336M0002X
TaxonomyMail Order Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: DAVID BALLARD
Title or Position: PIC
Credential: RPH
Phone: 336-367-5333