Provider Demographics
NPI:1447530092
Name:WALKER, RYAN G (PHARMD)
Entity type:Individual
Prefix:
First Name:RYAN
Middle Name:G
Last Name:WALKER
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3840 S 103RD EAST AVE
Mailing Address - Street 2:STE 234
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74146-2438
Mailing Address - Country:US
Mailing Address - Phone:918-660-0576
Mailing Address - Fax:918-660-0599
Practice Address - Street 1:3840 S 103RD EAST AVE
Practice Address - Street 2:STE 234
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74146-2438
Practice Address - Country:US
Practice Address - Phone:918-660-0576
Practice Address - Fax:918-660-0599
Is Sole Proprietor?:No
Enumeration Date:2011-08-26
Last Update Date:2011-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK13554183500000X
AZ13362183500000X
IL051.293796183500000X
ARPD10765183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist