Individual
BETHANY GAY WALLACE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
1405 OAK ST, KENOVA, WV 25530-1215
(304) 453-3504
Mailing address
12 BARTLETT ST, MILTON, WV 25541-8595
(812) 449-9470
Taxonomy
Speciality
Code
Description
License number
State
183500000X
Pharmacist
Primary
RP0005701
WV
Other
Enumeration date
11/18/2020
Last updated
11/18/2020
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