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Individual

EMILY BROOKE WALLACE

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
PHARM.D. CANDIDATE

Contact information

Practice address
2290 NE WESTWOOD DR APT H103, PULLMAN, WA 99163-5233
(406) 579-7205
Mailing address
2290 NE WESTWOOD DR APT H103, PULLMAN, WA 99163-5233
(406) 579-7205

Taxonomy

Speciality
Code
Description
License number
State
183500000X
Pharmacist
Primary
60302033
WA
183500000X
Pharmacist
E34399
ID
183500000X
Pharmacist
PHA-PIN-LIC-15878
MT

Other

Enumeration date
02/08/2016
Last updated
02/08/2016
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