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General NPI Number Information
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NPI Number | 1376143347
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Entity Type | Individual
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Provider Name | LISA RENAE WALTER RPH
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Gender | Female
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Dates
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Enumeration Date | 10/29/2020
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Last Update Date | 11/16/2024
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Provider Practice Location Address
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Address Line | 3106 CANTON ST
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City | HOPKINSVILLE
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State | KY
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Zip | 42240-1316
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Country | US
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Telephone | 606-673-4912
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Fax |
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Provider Business Mailing Address
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Address Line | 125 EMILYS WAY
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City | CADIZ
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State | KY
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Zip | 42211-9210
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Country | US
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Telephone | 304-563-8517
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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 | 010496
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License Number State | KY
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