Individual
LISA RENAE WALTER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
RPH
Contact information
Practice address
3106 CANTON ST, HOPKINSVILLE, KY 42240-1316
(606) 673-4912
Mailing address
125 EMILYS WAY, CADIZ, KY 42211-9210
(304) 563-8517
Taxonomy
Speciality
Code
Description
License number
State
183500000X
Pharmacist
Primary
010496
KY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
010496
KY BD OF PHARMACY
KY
01
—
03118910
OH BD OF PHARMACY
OH
Enumeration date
10/29/2020
Last updated
11/16/2024
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