Healthcare Provider Details

I. General information

NPI: 1770279887
Provider Name (Legal Business Name): MRS. AMIE LYNN WALTER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/12/2023
Last Update Date: 04/12/2023
Certification Date: 04/12/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

255 E MAIN ST
COLUMBUS OH
43215-5222
US

IV. Provider business mailing address

2368 SOUTHWAY DR
COLUMBUS OH
43221-3722
US

V. Phone/Fax

Practice location:
  • Phone: 614-355-1100
  • Fax:
Mailing address:
  • Phone: 614-893-5578
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number03-3-24281
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: