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Individual
TY MACWALTERS
Active
Individual
TY MACWALTERS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
CPHT
Taxonomy
Speciality
Code
Description
License number
State
3336I0012X
Institutional Pharmacy
Primary
037.0001187
VT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
121.0000650
STATE LICENSE
VT
Enumeration date
07/13/2017
Last updated
03/17/2018
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