Organization
WALFER CORP
Active
Organization
WALFER CORP
Active
Other names
Wallace Pharmacy, MEDICINE SHOPPE
Organization subpart
No
Provider details
NPI number
Authorized official
WAYNE WALLACE RPH. (OWNER/RPH)
(941) 627-9855
Entity
Organization
Contact information
Practice address
3524 TAMIAMI TRL # B, PORT CHARLOTTE, FL 33952-8100
(941) 627-9855
(941) 627-0658
Mailing address
3524B TAMIAMI TRL, PORT CHARLOTTE, FL 33952-8100
Taxonomy
Speciality
Code
Description
License number
State
333600000X
Pharmacy
PH9089
FL
3336C0003X
Community/Retail Pharmacy
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
101838800
—
FL
01
—
1052719
OTHER ID NUMBER-COMMERCIAL NUMBER
—
Enumeration date
08/20/2006
Last updated
03/07/2023
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