Individual
STEPHANIE LYNN WALLACE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
254 CASSIDY BLVD, PIKEVILLE, KY 41501-1426
(606) 432-6180
(606) 432-6182
Mailing address
108 SANDY ST, PIKEVILLE, KY 41501-2002
(606) 899-5738
Taxonomy
Speciality
Code
Description
License number
State
183500000X
Pharmacist
Primary
011733
KY
Other
Enumeration date
11/05/2020
Last updated
11/05/2020
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