Individual
MATTHEW WALLACE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
8141 SR-100, NASHVILLE, TN 37221
(615) 662-8885
Mailing address
120 S 5TH ST APT 432, NASHVILLE, TN 37206-4272
Taxonomy
Speciality
Code
Description
License number
State
183500000X
Pharmacist
24391
MD
183500000X
Pharmacist
Primary
45397
TN
Other
Enumeration date
08/28/2016
Last updated
09/23/2021
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