Individual
DR. MICAH JORDAN WALLACE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PHARM.D.
Contact information
Practice address
2152 SAVANNAH HWY, CHARLESTON, SC 29414-5311
(843) 556-8974
Mailing address
2152 SAVANNAH HWY, CHARLESTON, SC 29414-5311
(843) 556-8974
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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