Provider Demographics
NPI:1104914001
Name:WALKER, WILLIAM H (RPH)
Entity type:Individual
Prefix:
First Name:WILLIAM
Middle Name:H
Last Name:WALKER
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:838 4TH AVE
Mailing Address - Street 2:
Mailing Address - City:LAKE ODESSA
Mailing Address - State:MI
Mailing Address - Zip Code:48849-1002
Mailing Address - Country:US
Mailing Address - Phone:616-374-3190
Mailing Address - Fax:616-374-0921
Practice Address - Street 1:838 4TH AVE
Practice Address - Street 2:
Practice Address - City:LAKE ODESSA
Practice Address - State:MI
Practice Address - Zip Code:48849-1002
Practice Address - Country:US
Practice Address - Phone:616-374-3190
Practice Address - Fax:616-374-0921
Is Sole Proprietor?:No
Enumeration Date:2006-10-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5302024177183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist