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Individual
DR. MICAH JORDAN WALLACE
Active
Individual
DR. MICAH JORDAN WALLACE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PHARM.D.
Taxonomy
Speciality
Code
Description
License number
State
183500000X
Pharmacist
Primary
14060
SC
183500000X
Pharmacist
36630
TN
Other
Enumeration date
09/03/2013
Last updated
09/03/2013
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