Individual
MR. DUSTIN L WALLACE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
CPHT
Contact information
Practice address
2 SHIRCLIFF WAY STE 900, JACKSONVILLE, FL 32204-4753
(904) 389-9744
Mailing address
2952 ROSSELLE ST, JACKSONVILLE, FL 32205-5666
(615) 310-1217
(888) 974-6157
Taxonomy
Speciality
Code
Description
License number
State
183700000X
Pharmacy Technician
Primary
RPT57955
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
RPT57955
PHARMACY TECH
FL
Enumeration date
01/27/2021
Last updated
01/27/2021
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