MEDICARE: WALFER CORP

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	333600000X	Pharmacy	PH9089	FL
2	3336C0003X	Community/Retail Pharmacy

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier Issuer
1	1052719	OTHER	OTHER ID NUMBER-COMMERCIAL NUMBER
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1497860423
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	WALFER CORP

Provider Business Mailing Address
First Line	:	3524B TAMIAMI TRL
Second Line	:
City	:	PORT CHARLOTTE
State	:	FL
Zip	:	33952-8100
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	3524 TAMIAMI TRL # B
Second Line	:
City	:	PORT CHARLOTTE
State	:	FL
Zip	:	33952-8100
Country	:	US
Telephone Number	:	941-627-9855
Fax Number	:	941-627-0658

Authorized Official
Title or Position	:	OWNER/RPH
Name	:	WAYNE WALLACE
Credential	:	RPH.
Telephone Number	:	941-627-9855

Provider Enumeration Date	:	08/20/2006
Last Update Date	:	03/07/2023

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Directions to “WALFER CORP ” Practice Location

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