Provider Demographics
NPI:1972546125
Name:WALKER PHARMACY AND GIFTS, INC.
Entity type:Organization
Organization Name:WALKER PHARMACY AND GIFTS, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JORDAN
Authorized Official - Middle Name:DENT
Authorized Official - Last Name:WALKER
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMD
Authorized Official - Phone:912-681-3784
Mailing Address - Street 1:PO BOX 2087
Mailing Address - Street 2:
Mailing Address - City:STATESBORO
Mailing Address - State:GA
Mailing Address - Zip Code:30459-2087
Mailing Address - Country:US
Mailing Address - Phone:912-764-6715
Mailing Address - Fax:912-489-4649
Practice Address - Street 1:2425 NORTHSIDE DR W
Practice Address - Street 2:
Practice Address - City:STATESBORO
Practice Address - State:GA
Practice Address - Zip Code:30458-2153
Practice Address - Country:US
Practice Address - Phone:912-764-6715
Practice Address - Fax:912-489-4649
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-14
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA63653336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA00286899AMedicaid
GA1128811OtherNCPDP NUMBER
GAPHRE010914OtherSTATE LICENSE
GAPHRE010914OtherSTATE LICENSE