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NPI Code Detail

MEDICARE: RICKY DEAN WALL PHARM.D.

MEDICARE: RICKY DEAN WALL PHARM.D.
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
1183500000XPharmacist27381NC

General Provider Information

NPI Number : 1295222313
Entity Type Code : Individual
Provider Name (Legal Business Name) : RICKY DEAN WALL PHARM.D.
Provider Business Mailing Address
First Line : 9632 RICH HATCHET RD
Second Line :
City : HUNTERSVILLE
State : NC
Zip : 28078-8701
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 112 S SHARON AMITY RD
Second Line :
City : CHARLOTTE
State : NC
Zip : 28211-2802
Country : US
Telephone Number : 704-366-1675
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/13/2018
Last Update Date : 04/13/2018

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Directions to “ RICKY DEAN WALL PHARM.D.” Practice Location

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