Healthcare Provider Details

I. General information

NPI: 1366445827
Provider Name (Legal Business Name): WALTERS PHARMACY INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/27/2005
Last Update Date: 02/20/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

401 N 17TH ST SUITE 102
ALLENTOWN PA
18104-5034
US

IV. Provider business mailing address

401 N 17TH ST SUITE 102
ALLENTOWN PA
18104-5034
US

V. Phone/Fax

Practice location:
  • Phone: 610-435-4706
  • Fax: 610-435-2107
Mailing address:
  • Phone: 610-435-4706
  • Fax: 610-435-2107

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code3336C0004X
TaxonomyCompounding Pharmacy
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License NumberPP412814L
License Number StatePA

VIII. Authorized Official

Name: HOWARD ANTHONY
Title or Position: OWNER
Credential: RPH
Phone: 610-435-4706