Organization
DALLAS EXPRESS PHARMACY
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. JACOB TYLER WALLACE JR. R.PH. (PRESIDENT)
(704) 922-3001
Entity
Organization
Contact information
Practice address
111 NORTH HOFFMAN, SUITE A, DALLAS, NC 28034
(704) 922-3001
(704) 922-0060
Mailing address
111 NORTH HOFFMAN, SUITE A, DALLAS, NC 28034
(704) 922-3001
(704) 922-0060
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
Primary
9048
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0366203
—
NC
01
—
3403451
NCPDP
—
Enumeration date
03/21/2007
Last updated
09/21/2021
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