Individual
MR. DAVID C. WALLACE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
R.PH.
Contact information
Practice address
621 S NEW BALLAS RD, CREVE COEUR, MO 63141-8232
(314) 251-7444
(314) 251-7443
Mailing address
817 BROCKWELL DR, DARDENNE PRAIRIE, MO 63368-8373
Taxonomy
Speciality
Code
Description
License number
State
183500000X
Pharmacist
Primary
PH044996
MO
Other
Enumeration date
03/19/2007
Last updated
07/08/2007
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