Organization
WALLACE PHARMACY INC
Active
Other names
WALLACE DRUG
Organization subpart
No
Provider details
NPI number
Authorized official
DWIGHT WALLACE PHARMD (CEO/PIC)
(208) 397-4540
Entity
Organization
Contact information
Practice address
44 S MAIN, ABERDEEN, ID 83210-0841
(208) 397-4540
(208) 397-5215
Mailing address
44 S MAIN, PO BOX 841, ABERDEEN, ID 83210-0841
(208) 397-4540
(208) 397-5215
Taxonomy
Speciality
Code
Description
License number
State
333600000X
Pharmacy
—
—
3336C0003X
Community/Retail Pharmacy
Primary
1129RP
ID
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2019739
PK
—
05
—
2349700
—
ID
Enumeration date
01/16/2007
Last updated
03/10/2017
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