Healthcare Provider Details

I. General information

NPI: 1083191597
Provider Name (Legal Business Name): ANNETTE GOODWIN WALKER RPH, PHARMD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: ANNETTE GOODWIN WALKER RPH, PHARMD

II. Dates (important events)

Enumeration Date: 07/26/2018
Last Update Date: 07/26/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

18 CANSO ST
GREENVILLE SC
29607-6414
US

IV. Provider business mailing address

18 CANSO ST
GREENVILLE SC
29607-6414
US

V. Phone/Fax

Practice location:
  • Phone: 864-354-5815
  • Fax:
Mailing address:
  • Phone: 864-354-5815
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1835P0018X
TaxonomyPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
License Number9153
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: