Individual
DR. LARIQUE WALLACE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PHARMD
Contact information
Practice address
780 E MAIN ST, STAMFORD, CT 06902-3832
(203) 353-9117
Mailing address
780 E MAIN ST, STAMFORD, CT 06902-3832
(203) 353-9117
Taxonomy
Speciality
Code
Description
License number
State
183500000X
Pharmacist
Primary
PCT.0015392
CT
Other
Enumeration date
05/25/2021
Last updated
05/26/2021
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