Individual
LISA B. WALL
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
4714 HOLLADAY BLVD, HOLLADAY, UT 84117-5403
(801) 278-9767
Mailing address
4714 HOLLADAY BLVD, HOLLADAY, UT 84117-5403
(801) 278-9767
Taxonomy
Speciality
Code
Description
License number
State
183500000X
Pharmacist
Primary
153199-1701
UT
Other
Enumeration date
05/03/2011
Last updated
05/03/2011
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