Individual
THOMAS DANVILLE WALLACE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
CPHT
Contact information
Practice address
215 DEXTER L WOODS MEMORIAL BLVD, WAYNESBORO, TN 38485-2416
(931) 722-5466
Mailing address
501 HIGHWAY 64 W, WAYNESBORO, TN 38485-2355
(931) 722-3605
Taxonomy
Speciality
Code
Description
License number
State
183700000X
Pharmacy Technician
Primary
37742
TN
Other
Enumeration date
07/17/2012
Last updated
07/17/2012
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