Provider Demographics
NPI:1699730887
Name:WALTON, VIRGINIA O (RPH)
Entity type:Individual
Prefix:MS
First Name:VIRGINIA
Middle Name:O
Last Name:WALTON
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2119 WINTERS DR
Mailing Address - Street 2:
Mailing Address - City:PORTAGE
Mailing Address - State:MI
Mailing Address - Zip Code:49002-1637
Mailing Address - Country:US
Mailing Address - Phone:269-385-3293
Mailing Address - Fax:
Practice Address - Street 1:2103 PARKVIEW AVE
Practice Address - Street 2:
Practice Address - City:KALAMAZOO
Practice Address - State:MI
Practice Address - Zip Code:49008-3925
Practice Address - Country:US
Practice Address - Phone:269-344-2513
Practice Address - Fax:269-344-3952
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-04-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5302021652183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist