Individual
RYAN J WALLACE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
1493 CAMBRIDGE ST, CAMBRIDGE, MA 02139-1047
(617) 665-1000
Mailing address
21 THE LAURELS, ENFIELD, CT 06082-2350
(413) 454-7781
Taxonomy
Speciality
Code
Description
License number
State
183500000X
Pharmacist
Primary
PH239831
MA
Other
Enumeration date
10/20/2020
Last updated
10/20/2020
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