Provider Demographics
NPI:1285972273
Name:WALKER, HEATHER LYNN (RPH)
Entity type:Individual
Prefix:
First Name:HEATHER
Middle Name:LYNN
Last Name:WALKER
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:HEATHER
Other - Middle Name:LYNN
Other - Last Name:LUEDTKE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RPH
Mailing Address - Street 1:302 S GRAND AVE
Mailing Address - Street 2:
Mailing Address - City:SUN PRAIRIE
Mailing Address - State:WI
Mailing Address - Zip Code:53590-9827
Mailing Address - Country:US
Mailing Address - Phone:608-837-5949
Mailing Address - Fax:608-825-3253
Practice Address - Street 1:302 S GRAND AVE
Practice Address - Street 2:
Practice Address - City:SUN PRAIRIE
Practice Address - State:WI
Practice Address - Zip Code:53590-9827
Practice Address - Country:US
Practice Address - Phone:608-837-5949
Practice Address - Fax:608-825-3253
Is Sole Proprietor?:No
Enumeration Date:2013-01-25
Last Update Date:2013-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI13261-40183500000X
AZS010722183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist