Individual
DR. SANDRA MARIE WALLACE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PHARM.D.
Contact information
Practice address
4501 OUTER LOOP, LOUISVILLE, KY 40219-3856
(502) 969-2837
(502) 969-2856
Mailing address
205 TERRY DR, SHEPHERDSVILLE, KY 40165-7814
(502) 543-9089
Taxonomy
Speciality
Code
Description
License number
State
183500000X
Pharmacist
Primary
012689
KY
Other
Enumeration date
07/07/2006
Last updated
09/04/2007
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