MEDICARE: AMANDA DARLENE WALLS PHARMD

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	53947	TX
2	183500000X	Pharmacist	0202212536	VA

General Provider Information

NPI Number	:	1225463235
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	AMANDA DARLENE WALLS PHARMD

Provider Business Mailing Address
First Line	:	10801 WESTHEIMER RD
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77042-3201
Country	:	US
Telephone Number	:	713-580-0178
Fax Number	:

Provider Business Practice Location Address
First Line	:	10801 WESTHEIMER RD
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77042-3201
Country	:	US
Telephone Number	:	713-580-0178
Fax Number	:

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

Provider Enumeration Date	:	09/09/2013
Last Update Date	:	09/09/2013

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Directions to “ AMANDA DARLENE WALLS PHARMD” Practice Location

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