Individual
CLARISSA WALLACE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
3300 BEE CAVE RD STE 500, WEST LAKE HILLS, TX 78746-6770
(512) 329-7408
(512) 329-7411
Mailing address
3663 BRIARPARK DR, HOUSTON, TX 77042-5205
(713) 268-3630
(623) 869-1717
Taxonomy
Speciality
Code
Description
License number
State
183500000X
Pharmacist
Primary
40012
TX
Other
Enumeration date
07/12/2010
Last updated
07/12/2010
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