Individual
DR. VICTORIA L WALLACE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PHARMD
Contact information
Practice address
405 S 8TH STREET, PAYETTE, ID 83661
(208) 642-9331
Mailing address
2726 S MONTAUK AVE, BOISE, ID 83709-3300
(208) 890-6988
Taxonomy
Speciality
Code
Description
License number
State
183500000X
Pharmacist
Primary
P5339
ID
183500000X
Pharmacist
RPH0009655
OR
Other
Enumeration date
09/12/2011
Last updated
09/12/2011
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