Healthcare Provider Details

I. General information

NPI: 1548661663
Provider Name (Legal Business Name): KRYSTAL LAWSON WALTON PHARM.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/08/2014
Last Update Date: 09/08/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

175 FORUM DR
COLUMBIA SC
29229-7938
US

IV. Provider business mailing address

191 TWIN EAGLES DR
COLUMBIA SC
29203-9072
US

V. Phone/Fax

Practice location:
  • Phone: 803-606-6184
  • Fax:
Mailing address:
  • Phone: 803-606-6184
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number35794
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: