Provider Demographics
NPI:1992073407
Name:HARRELL, WALTER STANTON JR (RPH)
Entity type:Individual
Prefix:
First Name:WALTER
Middle Name:STANTON
Last Name:HARRELL
Suffix:JR
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4320 S NC HIGHWAY 150
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:NC
Mailing Address - Zip Code:27295-5161
Mailing Address - Country:US
Mailing Address - Phone:336-853-2744
Mailing Address - Fax:
Practice Address - Street 1:4320 S NC HIGHWAY 150
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:NC
Practice Address - Zip Code:27295-5161
Practice Address - Country:US
Practice Address - Phone:336-853-2744
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-12-12
Last Update Date:2016-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC07793183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist