Individual
MRS. MABLE WU WALLACE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
20070 ASHBROOK COMMONS PLZ, ASHBURN, VA 20147-5034
(571) 223-0517
(571) 223-0542
Mailing address
37081 ELAINE PL, PURCELLVILLE, VA 20132-5072
(703) 801-9967
Taxonomy
Speciality
Code
Description
License number
State
183500000X
Pharmacist
Primary
0202205009
VA
Other
Enumeration date
05/15/2011
Last updated
05/15/2011
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