Organization
J WALLACE LLC
Active
Other names
GRANT COUNTY DRUGS WILLIAMSTOWN
Organization subpart
No
Provider details
NPI number
Authorized official
JASON WALLACE PHARMD, RPH (OWNER)
(859) 824-4239
Entity
Organization
Contact information
Practice address
302A BARNES RD, WILLIAMSTOWN, KY 41097-9483
(859) 824-4239
(859) 824-2110
Mailing address
302 BARNES RD, WILLIAMSTOWN, KY 41097-9483
(859) 824-4239
(859) 824-2110
Taxonomy
Speciality
Code
Description
License number
State
332BC3200X
Customized Equipment (DME)
P06979
KY
3336C0003X
Community/Retail Pharmacy
Primary
PO6979
KY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2029150
PK
—
05
—
54009139
—
KY
05
—
90011560
—
KY
Enumeration date
09/12/2006
Last updated
05/02/2025
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