Individual
JEANETTE WALLACE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
RPH
Contact information
Practice address
9040 JACKSON AVE, TACOMA, WA 98431-6456
(253) 968-2252
Mailing address
21508 107TH AVE E, GRAHAM, WA 98338-6456
(253) 653-8659
Taxonomy
Speciality
Code
Description
License number
State
183500000X
Pharmacist
Primary
PH00015991
WA
Other
Enumeration date
09/01/2015
Last updated
07/29/2019
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