Individual
DWIGHT D. WALLACE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
PHARMD
Contact information
Practice address
44 S. MAIN ST, ABERDEEN, ID 83210
(208) 397-4540
Mailing address
PO BOX 841, ABERDEEN, ID 83210-0841
(208) 397-4540
Taxonomy
Speciality
Code
Description
License number
State
183500000X
Pharmacist
Primary
P4895
ID
Other
Enumeration date
04/11/2014
Last updated
04/11/2014
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