=====================================================
General NPI Number Information
=====================================================
NPI Number | 1154921898
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | LUKE WALKER
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/30/2020
-----------------------------------------------------
Last Update Date | 10/30/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2217 NW 23RD ST
-----------------------------------------------------
City | OKLAHOMA CITY
-----------------------------------------------------
State | OK
-----------------------------------------------------
Zip | 73107-2403
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 405-521-0804
-----------------------------------------------------
Fax | 405-521-0844
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2217 NW 23RD ST
-----------------------------------------------------
City | OKLAHOMA CITY
-----------------------------------------------------
State | OK
-----------------------------------------------------
Zip | 73107-2403
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 405-521-0804
-----------------------------------------------------
Fax | 405-521-0844
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 183500000X
-----------------------------------------------------
Taxonomy Name | Pharmacist
-----------------------------------------------------
License Number | 15456
-----------------------------------------------------
License Number State | OK
-----------------------------------------------------