Individual
KATHLEEN WALLACE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
600 S 70TH ST, LINCOLN, NE 68510-2451
(402) 489-3802
Mailing address
8364 ROCKLEDGE RD APT 521, LINCOLN, NE 68506-7361
Taxonomy
Speciality
Code
Description
License number
State
183500000X
Pharmacist
Primary
21705
IA
Other
Enumeration date
08/01/2012
Last updated
08/01/2012
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