Individual
MRS. DONNA C. WALLACE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PHARMD
Contact information
Practice address
1817 NW 127TH AVE, PEMBROKE PINES, FL 33028-2567
(954) 325-1495
Mailing address
1817 NW 127TH AVE, PEMBROKE PINES, FL 33028-2567
(954) 325-1495
Taxonomy
Speciality
Code
Description
License number
State
183500000X
Pharmacist
Primary
PS30769
FL
1835P2201X
Ambulatory Care Pharmacist
PU4665
FL
Other
Enumeration date
12/28/2017
Last updated
12/28/2017
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