MEDICARE: KEITH WALSH 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	37371	CA

General Provider Information

NPI Number	:	1679203970
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KEITH WALSH PHARMD

Provider Business Mailing Address
First Line	:	8441 N BOND ST
Second Line	:
City	:	FRESNO
State	:	CA
Zip	:	93720-2150
Country	:	US
Telephone Number	:	559-917-1749
Fax Number	:

Provider Business Practice Location Address
First Line	:	785 N MEDICAL CENTER DR W STE 304
Second Line	:
City	:	CLOVIS
State	:	CA
Zip	:	93611-6878
Country	:	US
Telephone Number	:	559-387-1861
Fax Number	:

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

Provider Enumeration Date	:	06/10/2022
Last Update Date	:	06/10/2022

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