Individual
SHAROLD NEASHA WALLACE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
190 N FLORISSANT RD, FERGUSON, MO 63135-1942
(314) 521-4518
Mailing address
190 N FLORISSANT RD, FERGUSON, MO 63135-1942
(314) 521-4518
Taxonomy
Speciality
Code
Description
License number
State
183700000X
Pharmacy Technician
Primary
2001021627
MO
Other
Enumeration date
11/21/2022
Last updated
11/21/2022
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