Individual
DR. JACOB TYLER WALLACE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
PHARMD
Contact information
Practice address
201 W MARION ST STE 100, SHELBY, NC 28150-5094
(980) 552-4402
(704) 831-8118
Mailing address
201 W MARION ST STE 100, SHELBY, NC 28150-5094
(980) 552-4402
(704) 831-8118
Taxonomy
Speciality
Code
Description
License number
State
183500000X
Pharmacist
Primary
21863
NC
Other
Enumeration date
08/25/2011
Last updated
02/02/2023
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