Individual
DR. JAMIE GLENN WALLER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
PHARM.D
Contact information
Practice address
12130 JEFFERSON AVE, NEWPORT NEWS, VA 23602-6908
(757) 881-9371
Mailing address
510 ELF TRAIL, BASSETT, VA 24055
(804) 921-6303
Taxonomy
Speciality
Code
Description
License number
State
183500000X
Pharmacist
Primary
0202211827
VA
Other
Enumeration date
12/11/2012
Last updated
12/11/2012
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