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General NPI Number Information
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NPI Number | 1124176136
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Entity Type | Organization
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Legal Business Name | WALTERS PHARMACY INC
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Dates
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Enumeration Date | 01/08/2007
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Last Update Date | 11/04/2014
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Provider Practice Location Address
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Address Line | 250 W PALM ST
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City | BELLVILLE
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State | TX
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Zip | 77418-1361
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Country | US
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Telephone | 979-865-3696
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Fax | 979-865-3697
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Provider Business Mailing Address
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Address Line | 250 W PALM ST
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City | BELLVILLE
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State | TX
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Zip | 77418-1361
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Country | US
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Telephone | 979-865-3696
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Fax | 979-865-3697
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Authorized Official
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Title or Position | PIC
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Name | MICHAEL KOEHN
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Credential | RPH
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Telephone | 979-865-3696
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 3336L0003X
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Taxonomy Name | Long Term Care Pharmacy
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 333600000X
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Taxonomy Name | Pharmacy
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 3336C0003X
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Taxonomy Name | Community/Retail Pharmacy
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License Number | 05941
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License Number State | TX
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