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Organization

DALLAS EXPRESS PHARMACY

Active
Organization subpart
No

Provider details

NPI number
Authorized official
MR. JACOB TYLER WALLACE JR. (PRESIDENT)
(704) 922-3001
Entity
Organization

Contact information

Practice address
111A N HOFFMAN ST, DALLAS, NC 28034-1597
(704) 922-3001
(704) 922-0060
Mailing address
111A N HOFFMAN ST, DALLAS, NC 28034-1597
(704) 922-3001
(704) 922-0060

Taxonomy

Speciality
Code
Description
License number
State
3336C0003X
Community/Retail Pharmacy
Primary
09048
NC

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
0366203
NC
01
3403451
NCPDP
NC
Enumeration date
04/06/2012
Last updated
09/21/2021
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