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General NPI Number Information
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NPI Number | 1588004857
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Entity Type | Individual
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Provider Name | KENNETH D WALKER RPH
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Gender | Male
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Dates
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Enumeration Date | 07/01/2013
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Last Update Date | 07/01/2013
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Provider Practice Location Address
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Address Line | 2101 E EVERGREEN DR
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City | APPLETON
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State | WI
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Zip | 54913-9001
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Country | US
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Telephone | 920-733-2305
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Fax | 920-733-3814
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Provider Business Mailing Address
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Address Line | 700 PILGRIM WAY
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City | GREEN BAY
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State | WI
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Zip | 54304-5263
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Country | US
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Telephone | 920-265-1944
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Fax | 920-429-8758
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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 | 13590-40
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License Number State | WI
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