Individual
DR. BRYCE ALEXANDER WALLACE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PHARMD
Contact information
Practice address
222 E MAIN ST, PORTAGEVILLE, MO 63873-1614
(573) 379-5460
(573) 379-5459
Mailing address
101 RICHLAND RD, PORTAGEVILLE, MO 63873-9102
(573) 724-2627
Taxonomy
Speciality
Code
Description
License number
State
183500000X
Pharmacist
Primary
2021038939
MO
Other
Enumeration date
08/29/2023
Last updated
08/29/2023
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