Individual
THADDAEUS WALLACE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PHARMD
Contact information
Practice address
1501 KINGS HWY, SHREVEPORT, LA 71103-4228
(318) 626-0852
Mailing address
1501 KINGS HWY, SHREVEPORT, LA 71103-4228
(318) 626-0852
Taxonomy
Speciality
Code
Description
License number
State
1835X0200X
Oncology Pharmacist
Primary
018835
LA
Other
Enumeration date
02/03/2026
Last updated
02/03/2026
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