Individual
SPENCER ALLEN WALLACE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
1599 J ST, GRAND FORKS AFB, ND 58205-6306
(701) 747-5382
Mailing address
1052 FIR AVE, GRAND FORKS AFB, ND 58204-1299
(801) 560-4315
Taxonomy
Speciality
Code
Description
License number
State
183500000X
Pharmacist
Primary
18471
OK
Other
Enumeration date
12/04/2019
Last updated
12/04/2019
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