Provider Demographics
NPI:1780260679
Name:WALKER, JUANITA (RPH)
Entity type:Individual
Prefix:
First Name:JUANITA
Middle Name:
Last Name:WALKER
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6463 S FALKENBURG RD
Mailing Address - Street 2:
Mailing Address - City:RIVERVIEW
Mailing Address - State:FL
Mailing Address - Zip Code:33578-8696
Mailing Address - Country:US
Mailing Address - Phone:833-796-1527
Mailing Address - Fax:844-738-9862
Practice Address - Street 1:6463 S FALKENBURG RD
Practice Address - Street 2:
Practice Address - City:RIVERVIEW
Practice Address - State:FL
Practice Address - Zip Code:33578-8696
Practice Address - Country:US
Practice Address - Phone:833-796-1527
Practice Address - Fax:844-738-9862
Is Sole Proprietor?:Yes
Enumeration Date:2021-03-22
Last Update Date:2021-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL0026195183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLPS0026195OtherPHARMACY LICENSE
FL560375OtherNABP