Healthcare Provider Details

I. General information

NPI: 1043146459
Provider Name (Legal Business Name): WALKER SHANE ELLIOTT RPH, PHARMD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/23/2026
Last Update Date: 06/23/2026
Certification Date: 06/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

715 RICHLAND MALL
ONTARIO OH
44906-3802
US

IV. Provider business mailing address

417 W BROADWAY ST
PLYMOUTH OH
44865-1026
US

V. Phone/Fax

Practice location:
  • Phone: 567-307-7557
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number03446765
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: