Provider Demographics
NPI:1386908069
Name:WALZ, DONALD (RPH)
Entity type:Individual
Prefix:MR
First Name:DONALD
Middle Name:
Last Name:WALZ
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 1:8009 OLD ORCHARD TRL
Mailing Address - Street 2:
Mailing Address - City:EVANSVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:47712-7328
Mailing Address - Country:US
Mailing Address - Phone:812-480-2845
Mailing Address - Fax:
Practice Address - Street 1:8009 OLD ORCHARD TRL
Practice Address - Street 2:
Practice Address - City:EVANSVILLE
Practice Address - State:IN
Practice Address - Zip Code:47712-7328
Practice Address - Country:US
Practice Address - Phone:812-480-2845
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-06-27
Last Update Date:2012-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN26014893A183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist