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General NPI Number Information
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NPI Number | 1134874480
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Entity Type | Individual
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Provider Name | DEBORAH KOON WALLS PHARMD
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Gender | Female
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Dates
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Enumeration Date | 02/15/2022
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Last Update Date | 02/15/2022
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Provider Practice Location Address
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Address Line | 60 CASSIDY WAY
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City | DANVILLE
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State | KY
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Zip | 40422-8472
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Country | US
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Telephone | 859-936-1222
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Fax |
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Provider Business Mailing Address
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Address Line | 4435 LEBANON RD
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City | DANVILLE
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State | KY
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Zip | 40422-9626
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Country | US
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Telephone | 404-863-4575
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 183500000X
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Taxonomy Name | Pharmacist
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License Number | 017439
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License Number State | KY
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