Healthcare Provider Details

I. General information

NPI: 1881786358
Provider Name (Legal Business Name): WALKER DRUG COMPANY INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/29/2006
Last Update Date: 09/16/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

290 S. MAIN ST.
MOAB UT
84532
US

IV. Provider business mailing address

290 S. MAIN ST.
MOAB UT
84532
US

V. Phone/Fax

Practice location:
  • Phone: 435-259-5959
  • Fax: 435-259-0174
Mailing address:
  • Phone: 435-259-5959
  • Fax: 435-259-0174

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number87418
License Number StateUT
# 2
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number1188021703
License Number StateUT

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier4601743
Identifier TypeOTHER
Identifier StateUT
Identifier IssuerNABP

VIII. Authorized Official

Name: MR. JACK WALKER
Title or Position: PRESIDENT/OWNEE
Credential: PHARMACIST
Phone: 435-259-5959