Individual
DR. KRISTIE JACKSON WALLACE
Active
Sole proprietor
Provider details
NPI number
Gender
F
Credential
PHARMD
Contact information
Practice address
499 LAGUNA DR, ST PETERSBURG, FL 33715-1842
(727) 542-1340
(727) 865-6040
Mailing address
585 CAPRI BLVD, TREASURE ISLAND, FL 33706-2943
(727) 363-4135
Taxonomy
Speciality
Code
Description
License number
State
1835P1200X
Pharmacotherapy Pharmacist
Primary
PS27159
FL
Other
Enumeration date
05/27/2005
Last updated
07/08/2007
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