MEDICARE: SONJA LYNNE WALLS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	183500000X	Pharmacist	32312	TX

General Provider Information

NPI Number	:	1013632868
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SONJA LYNNE WALLS

Provider Business Mailing Address
First Line	:	181 DAHLIA RD
Second Line	:
City	:	HUNTSVILLE
State	:	TX
Zip	:	77320-0746
Country	:	US
Telephone Number	:	936-718-6614
Fax Number	:

Provider Business Practice Location Address
First Line	:	2421 SAM HOUSTON AVE
Second Line	:
City	:	HUNTSVILLE
State	:	TX
Zip	:	77340-5862
Country	:	US
Telephone Number	:	936-439-9038
Fax Number	:	936-436-9198

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/04/2022
Last Update Date	:	10/04/2022

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Directions to “ SONJA LYNNE WALLS ” Practice Location

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