Individual
MR. JOHN MARK WALLACE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
R.PH.
Contact information
Practice address
500 FOOTHILL BLVD, SALT LAKE CITY, UT 84148-0001
(801) 582-1565
(801) 584-2530
Mailing address
1422 E 9090 S, SANDY, UT 84093-2203
(801) 582-1565
(801) 584-2530
Taxonomy
Speciality
Code
Description
License number
State
183500000X
Pharmacist
Primary
3169351701
UT
Other
Enumeration date
07/12/2006
Last updated
07/08/2007
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