Organization
WALTER LAGESTEE INCORPORATED
Active
Other names
Walt's Pharmacy #5
Organization subpart
No
Provider details
NPI number
Authorized official
PATRICK J EGAN PHARMACIST (THIRD PARTY COORDINATOR)
(708) 957-2974
Entity
Organization
Contact information
Practice address
1218 SHEFFIELD AVE, DYER, IN 46311-1053
(219) 865-4363
(219) 865-4365
Mailing address
1218 SHEFFIELD AVE, DYER, IN 46311-1053
(219) 865-4363
(219) 865-4365
Taxonomy
Speciality
Code
Description
License number
State
3336C0003X
Community/Retail Pharmacy
Primary
60005711A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
200422800
—
IN
Enumeration date
10/26/2006
Last updated
11/16/2012
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