Individual
STEPHANIE WALLACE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PHARMD
Contact information
Practice address
815 CHEYENNE MEADOWS RD, COLORADO SPRINGS, CO 80906-4929
(719) 527-1640
Mailing address
815 CHEYENNE MEADOWS RD, COLORADO SPRINGS, CO 80906-4929
(719) 527-1640
Taxonomy
Speciality
Code
Description
License number
State
183500000X
Pharmacist
0020679
CO
183500000X
Pharmacist
058853
NY
183500000X
Pharmacist
33624
TN
3336C0003X
Community/Retail Pharmacy
Primary
0020679
CO
Other
Enumeration date
02/02/2015
Last updated
10/05/2020
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