Individual
R SCOTT WALLACE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
RPH
Contact information
Practice address
19 DODGE ST, BEVERLY, MA 01915-1705
(978) 927-0060
Mailing address
19 DODGE ST, BEVERLY, MA 01915-1705
Taxonomy
Speciality
Code
Description
License number
State
183500000X
Pharmacist
Primary
PH22516
MA
1835P2201X
Ambulatory Care Pharmacist
PH22516
MA
Other
Enumeration date
11/22/2020
Last updated
11/22/2020
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