Provider Demographics
NPI:1265715379
Name:WALTHER, PATRICIA ANN (RPH)
Entity type:Individual
Prefix:MS
First Name:PATRICIA
Middle Name:ANN
Last Name:WALTHER
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4901 SPRING ST
Mailing Address - Street 2:
Mailing Address - City:MOUNT PLEASANT
Mailing Address - State:WI
Mailing Address - Zip Code:53406-2901
Mailing Address - Country:US
Mailing Address - Phone:262-886-9683
Mailing Address - Fax:
Practice Address - Street 1:4901 SPRING ST
Practice Address - Street 2:
Practice Address - City:MOUNT PLEASANT
Practice Address - State:WI
Practice Address - Zip Code:53406-2901
Practice Address - Country:US
Practice Address - Phone:262-886-9683
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-09-25
Last Update Date:2011-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI11606-040183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist