Organization
WALTMOOR CORP
Active
Other names
WALTERS PHARMACY SHOPPE
Organization subpart
No
Provider details
NPI number
Authorized official
TRENT WALTERS (OWNER)
(606) 248-8900
Entity
Organization
Contact information
Practice address
3603 CUMBERLAND AVE, MIDDLESBORO, KY 40965-2613
(606) 248-8900
(606) 248-8901
Mailing address
3603 CUMBERLAND AVE, PO BOX 07, MIDDLESBORO, KY 40965-2613
Taxonomy
Speciality
Code
Description
License number
State
333600000X
Pharmacy
—
—
3336C0003X
Community/Retail Pharmacy
Primary
007132
KY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1813787
NCPDP PROVIDER IDENTIFICATION NUMBER
—
05
—
1813787
—
TN
05
—
54017041
—
KY
Enumeration date
01/08/2007
Last updated
04/01/2010
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