Provider Demographics
NPI:1356980429
Name:WALSH, PATRICIA ANN (RPH)
Entity type:Individual
Prefix:
First Name:PATRICIA
Middle Name:ANN
Last Name:WALSH
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 1:2705 LAS PALMAS AVE
Mailing Address - Street 2:
Mailing Address - City:ESCONDIDO
Mailing Address - State:CA
Mailing Address - Zip Code:92025-7339
Mailing Address - Country:US
Mailing Address - Phone:760-484-7057
Mailing Address - Fax:
Practice Address - Street 1:6725 MESA RIDGE RD STE 230
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92121-2925
Practice Address - Country:US
Practice Address - Phone:888-963-6544
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-01-06
Last Update Date:2020-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA40426183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist