Individual
HOLLI NOELLE WALLACE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
2210 SUNRISE BLVD, RANCHO CORDOVA, CA 95670
(916) 638-0214
(916) 638-2513
Mailing address
6231 BURICH AVE, #61, CITRUS HEIGHTS, CA 95610
(916) 844-4063
Taxonomy
Speciality
Code
Description
License number
State
183700000X
Pharmacy Technician
Primary
—
—
Other
Enumeration date
12/19/2006
Last updated
07/08/2007
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