Provider Demographics
NPI:1548661663
Name:WALTON, KRYSTAL LAWSON (PHARMD)
Entity type:Individual
Prefix:
First Name:KRYSTAL
Middle Name:LAWSON
Last Name:WALTON
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:191 TWIN EAGLES DR
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:SC
Mailing Address - Zip Code:29203-9072
Mailing Address - Country:US
Mailing Address - Phone:803-606-6184
Mailing Address - Fax:
Practice Address - Street 1:175 FORUM DR
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29229-7938
Practice Address - Country:US
Practice Address - Phone:803-606-6184
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-09-08
Last Update Date:2014-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC35794183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC35794OtherSOUTH CAROLINA BOARD OF PHARMACY