Provider Demographics
NPI:1063998581
Name:WALKER, SERENA LISA (PHARM D)
Entity type:Individual
Prefix:
First Name:SERENA
Middle Name:LISA
Last Name:WALKER
Suffix:
Gender:F
Credentials:PHARM D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:833 ASHTON WAY CIR
Mailing Address - Street 2:
Mailing Address - City:EUREKA
Mailing Address - State:MO
Mailing Address - Zip Code:63025-4012
Mailing Address - Country:US
Mailing Address - Phone:314-570-8875
Mailing Address - Fax:
Practice Address - Street 1:245 E 5TH ST
Practice Address - Street 2:
Practice Address - City:EUREKA
Practice Address - State:MO
Practice Address - Zip Code:63025-1223
Practice Address - Country:US
Practice Address - Phone:636-938-4976
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-07-17
Last Update Date:2018-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO044861183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist