Provider Demographics
NPI:1447453667
Name:WALSH, PAMELA (PHARMD)
Entity type:Individual
Prefix:MRS
First Name:PAMELA
Middle Name:
Last Name:WALSH
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:271 VILLAGE RUN E
Mailing Address - Street 2:
Mailing Address - City:ENCINITAS
Mailing Address - State:CA
Mailing Address - Zip Code:92024-3045
Mailing Address - Country:US
Mailing Address - Phone:760-634-1891
Mailing Address - Fax:760-634-1891
Practice Address - Street 1:271 VILLAGE RUN E
Practice Address - Street 2:
Practice Address - City:ENCINITAS
Practice Address - State:CA
Practice Address - Zip Code:92024-3045
Practice Address - Country:US
Practice Address - Phone:760-634-1891
Practice Address - Fax:760-634-1891
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA53656183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA53656OtherPHARMACIST LICENSE NUMBER