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Individual

KAREN ELIZABETH BRUESTLE-WALLACE

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
PHARMD

Contact information

Practice address
4996 COUNTRY CLUB RD, WINSTON SALEM, NC 27104-4506
(336) 774-8420
Mailing address
4996 COUNTRY CLUB RD, WINSTON SALEM, NC 27104-4506
(336) 666-0093

Taxonomy

Speciality
Code
Description
License number
State
183500000X
Pharmacist
11872
AL
183500000X
Pharmacist
Primary
27331
NC
183500000X
Pharmacist
40764
TN
183500000X
Pharmacist
PS25711
FL

Other

Enumeration date
05/22/2023
Last updated
05/22/2023
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