Provider Demographics
NPI:1396070306
Name:WALKER, THOMAS LEE (RPH)
Entity type:Individual
Prefix:MR
First Name:THOMAS
Middle Name:LEE
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 1:3590 NW 17TH ST
Mailing Address - Street 2:
Mailing Address - City:LAUDERHILL
Mailing Address - State:FL
Mailing Address - Zip Code:33311-4204
Mailing Address - Country:US
Mailing Address - Phone:954-588-8043
Mailing Address - Fax:954-366-6523
Practice Address - Street 1:3590 NW 17TH ST
Practice Address - Street 2:
Practice Address - City:LAUDERHILL
Practice Address - State:FL
Practice Address - Zip Code:33311-4204
Practice Address - Country:US
Practice Address - Phone:954-588-8043
Practice Address - Fax:954-366-6523
Is Sole Proprietor?:Yes
Enumeration Date:2009-10-08
Last Update Date:2009-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS16601183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLPS16601OtherPHARMACY LICENCE