Provider Demographics
NPI:1386130912
Name:WALTERS, ROBERT ROY (RPH)
Entity type:Individual
Prefix:
First Name:ROBERT
Middle Name:ROY
Last Name:WALTERS
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 1:3545 OLENTANGY RIVER RD STE 100
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43214-3995
Mailing Address - Country:US
Mailing Address - Phone:614-566-4422
Mailing Address - Fax:614-566-6999
Practice Address - Street 1:3545 OLENTANGY RIVER RD STE 100
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43214-3995
Practice Address - Country:US
Practice Address - Phone:614-566-4422
Practice Address - Fax:614-566-6999
Is Sole Proprietor?:No
Enumeration Date:2018-07-06
Last Update Date:2018-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH13265183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist