Individual
CARY LEE WALLACE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PHARM.D.
Contact information
Practice address
300 W OAK ST, AMITE, LA 70422-2720
(985) 747-8342
Mailing address
300 W OAK ST, AMITE, LA 70422-2720
(985) 747-8342
Taxonomy
Speciality
Code
Description
License number
State
183500000X
Pharmacist
Primary
020367
LA
Other
Enumeration date
12/12/2013
Last updated
03/17/2015
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