Provider Demographics
NPI:1588278881
Name:WALKER, KENICIA M (PHARMD, MSPH)
Entity type:Individual
Prefix:
First Name:KENICIA
Middle Name:M
Last Name:WALKER
Suffix:
Gender:F
Credentials:PHARMD, MSPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:153 W KINDERTON WAY
Mailing Address - Street 2:
Mailing Address - City:BERMUDA RUN
Mailing Address - State:NC
Mailing Address - Zip Code:27006-7392
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:MEDICAL CENTER BOULEVARD
Practice Address - Street 2:
Practice Address - City:WINSTON SALEM
Practice Address - State:NC
Practice Address - Zip Code:27157-0001
Practice Address - Country:US
Practice Address - Phone:336-716-5946
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-09-03
Last Update Date:2020-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC29690183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist