Individual
KELSEY WALLACE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PHARMD
Contact information
Practice address
522 NW 24TH CIR, CAMAS, WA 98607
(360) 904-6581
Mailing address
2335 NW RALEIGH ST UNIT 421, PORTLAND, OR 97210-3731
Taxonomy
Speciality
Code
Description
License number
State
183500000X
Pharmacist
Primary
00070414
WA
183500000X
Pharmacist
RPH-0011606
OR
1835P0018X
Pharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
RPH-0011606
OR
Other
Enumeration date
08/18/2009
Last updated
05/20/2019
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