Healthcare Provider Details

I. General information

NPI: 1073353025
Provider Name (Legal Business Name): LEXUS WALKER
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/28/2024
Last Update Date: 09/09/2026
Certification Date: 09/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16300 SE EVELYN ST
CLACKAMAS OR
97015-9515
US

IV. Provider business mailing address

16300 SE EVELYN ST
CLACKAMAS OR
97015-9515
US

V. Phone/Fax

Practice location:
  • Phone: 877-723-3929
  • Fax:
Mailing address:
  • Phone: 877-723-3929
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code333600000X
TaxonomyPharmacy
License NumberRPH-0021196
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: