Individual
MS. STACEY ANN WALLACE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
CPHT
Contact information
Practice address
3390 WEST RD, TRENTON, MI 48183-2323
(734) 676-6622
(734) 676-4166
Mailing address
3390 WEST RD, TRENTON, MI 48183-2323
(734) 676-6622
(734) 676-4166
Taxonomy
Speciality
Code
Description
License number
State
183700000X
Pharmacy Technician
Primary
5303003960
MI
Other
Enumeration date
08/31/2015
Last updated
08/31/2015
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