Individual
DELTHA L WALLACE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
RPH
Contact information
Practice address
1454 W CENTER RD, ESSEXVILLE, MI 48732-2112
(989) 895-4570
(989) 895-4569
Mailing address
3021 SHANNON LN, BAY CITY, MI 48706-2317
(989) 686-8425
Taxonomy
Speciality
Code
Description
License number
State
183500000X
Pharmacist
Primary
5302022089
MI
Other
Enumeration date
09/14/2006
Last updated
07/08/2007
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