Individual
MS. DIANE ELIZABETH WALLACE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
R.PH.
Contact information
Practice address
50 N MEDICAL DR, ROOM 1400, SALT LAKE CITY, UT 84132
(801) 581-2276
(801) 585-2306
Mailing address
1456 WASATCH DR, SALT LAKE CITY, UT 84108-2472
(801) 582-8909
(801) 565-2306
Taxonomy
Speciality
Code
Description
License number
State
183500000X
Pharmacist
Primary
1433401701
UT
Other
Enumeration date
12/26/2006
Last updated
07/08/2007
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