Individual
MS. JACQUELINE WALLACE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
1520 MAIN ST, WINDSOR, CO 80550-7909
(970) 674-2840
(970) 674-2843
Mailing address
1520 MAIN ST, WINDSOR, CO 80550-7909
(970) 674-2840
(970) 674-2843
Taxonomy
Speciality
Code
Description
License number
State
183500000X
Pharmacist
Primary
15631
CO
Other
Enumeration date
04/06/2013
Last updated
04/06/2013
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