Provider Demographics
NPI:1063531127
Name:WALKER, MARY D (PHARMD)
Entity type:Individual
Prefix:DR
First Name:MARY
Middle Name:D
Last Name:WALKER
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 1:5305 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:WILLIAMSVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:14221-5329
Mailing Address - Country:US
Mailing Address - Phone:716-631-2701
Mailing Address - Fax:
Practice Address - Street 1:5305 MAIN ST
Practice Address - Street 2:
Practice Address - City:WILLIAMSVILLE
Practice Address - State:NY
Practice Address - Zip Code:14221-5329
Practice Address - Country:US
Practice Address - Phone:716-631-2701
Practice Address - Fax:716-631-2707
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-28
Last Update Date:2015-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY20 045885183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY045885OtherPHARMACIST