Basic Information
Provider Information
NPI: 1316973126
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: WALKER
FirstName: CRAMER
MiddleName: SMITH
NamePrefix: MRS.
NameSuffix:  
Credential: RPH
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 25 PEARSON ST
Address2:  
City: LILLINGTON
State: NC
PostalCode: 275468205
CountryCode: US
TelephoneNumber: 9108938030
FaxNumber:  
Practice Location
Address1: 2300 RAMSEY ST
Address2:  
City: FAYETTEVILLE
State: NC
PostalCode: 283013856
CountryCode: US
TelephoneNumber: 9108227083
FaxNumber: 9108227945
Other Information
ProviderEnumerationDate: 06/23/2006
LastUpdateDate: 07/08/2007
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
183500000X08205NCY Pharmacy Service ProvidersPharmacist 

No ID Information.


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