Provider Demographics
NPI:1053614800
Name:WALKER, EDWIN J (RPH)
Entity type:Individual
Prefix:MR
First Name:EDWIN
Middle Name:J
Last Name:WALKER
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1009 CALLE MONTE TORRECILLAS
Mailing Address - Street 2:QUINTAS DE ALTAMIRA
Mailing Address - City:JUANA DIAZ
Mailing Address - State:PR
Mailing Address - Zip Code:00795-9101
Mailing Address - Country:US
Mailing Address - Phone:787-240-0611
Mailing Address - Fax:
Practice Address - Street 1:CARRETERA ESTATAL 153 KM 7.2
Practice Address - Street 2:
Practice Address - City:SANTA ISABEL
Practice Address - State:PR
Practice Address - Zip Code:00757
Practice Address - Country:US
Practice Address - Phone:787-971-1011
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-12-17
Last Update Date:2010-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR2926183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist