Individual
JESSICA WALLACE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
111 MICHIGAN AVE NW, WASHINGTON, DC 20010-2916
(202) 476-8586
Mailing address
111 MICHIGAN AVE NW, WASHINGTON, DC 20010-2916
(202) 476-8586
Taxonomy
Speciality
Code
Description
License number
State
183500000X
Pharmacist
Primary
PH100002131
DC
183500000X
Pharmacist
RPH026896
GA
Other
Enumeration date
01/14/2013
Last updated
06/15/2021
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