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General NPI Number Information
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NPI Number | 1427037688
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Entity Type | Organization
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Legal Business Name | WALLYS PHARMACY
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Dates
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Enumeration Date | 01/16/2006
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Last Update Date | 06/16/2008
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Provider Practice Location Address
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Address Line | 540 BROAD AVE
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City | BELLE VERNON
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State | PA
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Zip | 15012-1435
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Country | US
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Telephone | 724-929-7330
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Fax | 724-929-7373
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Provider Business Mailing Address
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Address Line | 540 BROAD AVE
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City | BELLE VERNON
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State | PA
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Zip | 15012-1435
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Country | US
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Telephone | 724-929-7330
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Fax | 724-929-7330
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Authorized Official
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Title or Position | OWNER-PHARMACIST
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Name | MR. WALTER ALAN ROBINSON
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Credential | BS, RPH
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Telephone | 724-929-7330
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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 | PP414089L
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License Number State | PA
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