Provider Demographics
NPI:1427325489
Name:FRUCHEY, WALTER LYN (PHARMD)
Entity type:Individual
Prefix:
First Name:WALTER
Middle Name:LYN
Last Name:FRUCHEY
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:400 W CAPITOL AVE # 100B
Mailing Address - Street 2:
Mailing Address - City:LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72201-3436
Mailing Address - Country:US
Mailing Address - Phone:501-374-2207
Mailing Address - Fax:501-374-2208
Practice Address - Street 1:400 W CAPITOL AVE # 100B
Practice Address - Street 2:
Practice Address - City:LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72201-3436
Practice Address - Country:US
Practice Address - Phone:501-374-2207
Practice Address - Fax:501-374-2208
Is Sole Proprietor?:No
Enumeration Date:2011-11-18
Last Update Date:2011-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARPD07259183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist