Provider Demographics
NPI:1982663852
Name:GARDIPEE, WALTER THOMAS (PHARMD, JD, MBA)
Entity type:Individual
Prefix:DR
First Name:WALTER
Middle Name:THOMAS
Last Name:GARDIPEE
Suffix:
Gender:M
Credentials:PHARMD, JD, MBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7426 E BEAVER VALLEY RD
Mailing Address - Street 2:
Mailing Address - City:PRESCOTT VALLEY
Mailing Address - State:AZ
Mailing Address - Zip Code:86314-1402
Mailing Address - Country:US
Mailing Address - Phone:402-980-9878
Mailing Address - Fax:
Practice Address - Street 1:650 EAST INDIAN SCHOOL RD
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85012-1492
Practice Address - Country:US
Practice Address - Phone:602-277-5551
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-03-20
Last Update Date:2024-12-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIPH-4331183500000X
NE12281183500000X
AZ14110183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist