Individual
AMBER WALTER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
125 COURT ST, JACKSON, MO 63755-1807
(573) 243-3524
Mailing address
125 COURT ST, JACKSON, MO 63755-1807
(573) 243-3524
Taxonomy
Speciality
Code
Description
License number
State
183500000X
Pharmacist
Primary
2008027467
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
600130504
—
MO
05
—
600995807
—
MO
Enumeration date
04/19/2016
Last updated
04/19/2016
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