Individual
DANIEL WALLER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
3200 LAFAYETTE BLVD, NORFOLK, VA 23509-2548
(757) 852-2603
Mailing address
3200 LAFAYETTE BLVD, NORFOLK, VA 23509-2548
(757) 852-2603
Taxonomy
Speciality
Code
Description
License number
State
183500000X
Pharmacist
Primary
0202211653
VA
Other
Enumeration date
11/24/2020
Last updated
11/24/2020
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