Provider Demographics
NPI:1659830701
Name:WALKER & WYATT, LLC
Entity type:Organization
Organization Name:WALKER & WYATT, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:LISA
Authorized Official - Middle Name:JANE
Authorized Official - Last Name:LAWSON
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMD
Authorized Official - Phone:865-579-4547
Mailing Address - Street 1:2541 E BROADWAY AVE
Mailing Address - Street 2:
Mailing Address - City:MARYVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37804-2760
Mailing Address - Country:US
Mailing Address - Phone:865-983-9591
Mailing Address - Fax:865-983-6632
Practice Address - Street 1:2541 E BROADWAY AVE
Practice Address - Street 2:
Practice Address - City:MARYVILLE
Practice Address - State:TN
Practice Address - Zip Code:37804-2760
Practice Address - Country:US
Practice Address - Phone:865-983-9591
Practice Address - Fax:865-983-6632
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:WALKER & WYATT, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2019-03-18
Last Update Date:2019-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes333600000XSuppliersPharmacy
No183500000XPharmacy Service ProvidersPharmacistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TNQ046535Medicaid