Individual
MO WALTS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
100 RANO BLVD, VESTAL, NY 13850-2776
(607) 763-8712
Mailing address
3606 PARTI DR, CORTLAND, NY 13045-8828
(607) 745-7752
Taxonomy
Speciality
Code
Description
License number
State
183700000X
Pharmacy Technician
Primary
20-102791
NY
Other
Enumeration date
09/18/2023
Last updated
09/18/2023
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