Healthcare Provider Details

I. General information

NPI: 1184612608
Provider Name (Legal Business Name): HEATHER WALSH RPH
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 10/10/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2665 BRODHEAD RD
ALIQUIPPA PA
15001-2723
US

IV. Provider business mailing address

21 MASON DR
CORAOPOLIS PA
15108-3437
US

V. Phone/Fax

Practice location:
  • Phone: 724-378-4141
  • Fax:
Mailing address:
  • Phone: 724-378-4141
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberRP044860L
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: