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General NPI Number Information
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NPI Number | 1598013062
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Entity Type | Individual
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Provider Name | ANTHONY S. WALL PHARM. D.
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Gender | Male
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Dates
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Enumeration Date | 08/15/2012
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Last Update Date | 08/15/2012
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Provider Practice Location Address
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Address Line | 7311 E 29TH DR
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City | DENVER
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State | CO
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Zip | 80238-2964
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Country | US
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Telephone | 720-214-5332
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Fax |
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Provider Business Mailing Address
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Address Line | 2821 DAHLIA ST
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City | DENVER
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State | CO
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Zip | 80207-3054
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Country | US
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Telephone | 303-296-1893
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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 | 17509
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License Number State | CO
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