Provider Demographics
NPI:1730438821
Name:MCKINNEY, WALTER MARSHALL (PHARMD)
Entity type:Individual
Prefix:
First Name:WALTER
Middle Name:MARSHALL
Last Name:MCKINNEY
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1008 LAKE MURRAY BLVD.
Mailing Address - Street 2:
Mailing Address - City:IRMO
Mailing Address - State:SC
Mailing Address - Zip Code:29063
Mailing Address - Country:US
Mailing Address - Phone:803-749-3843
Mailing Address - Fax:803-732-2825
Practice Address - Street 1:1008 LAKE MURRAY BLVD.
Practice Address - Street 2:
Practice Address - City:IRMO
Practice Address - State:SC
Practice Address - Zip Code:29063
Practice Address - Country:US
Practice Address - Phone:803-749-3843
Practice Address - Fax:803-732-2825
Is Sole Proprietor?:Yes
Enumeration Date:2012-09-05
Last Update Date:2012-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC9645183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist