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Individual

JENNIE ANESIA WALLACE

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
PHARMD

Contact information

Practice address
8551 WHITFIELD AVE, LEEDS, AL 35094-7560
(205) 699-0677
(205) 699-0715
Mailing address
228 WINDCHASE DR, BIRMINGHAM, AL 35242-4640
(205) 862-0022
(205) 699-0715

Taxonomy

Speciality
Code
Description
License number
State
183500000X
Pharmacist
Primary
13890
AL

Other

Enumeration date
06/09/2017
Last updated
06/09/2017
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