Individual
NICOLE WALLACE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
675 N SAINT CLAIR ST STE 19-100, CHICAGO, IL 60611-5969
(312) 926-2749
(312) 694-6830
Mailing address
675 N SAINT CLAIR ST STE 19-100, CHICAGO, IL 60611-5969
(312) 926-2749
(312) 694-6830
Taxonomy
Speciality
Code
Description
License number
State
183700000X
Pharmacy Technician
Primary
049290929
IL
Other
Enumeration date
09/25/2025
Last updated
09/25/2025
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