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Individual

DR. TAKOVA WALLACE

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
PHARMD

Contact information

Practice address
215 PERRY HILL RD, MONTGOMERY, AL 36109-3725
(334) 272-4670
Mailing address
160 STONE PARK BLVD APT 2313, PIKE ROAD, AL 36064-3023
(256) 322-0820

Taxonomy

Speciality
Code
Description
License number
State
183500000X
Pharmacist
Primary
17723
AL

Other

Enumeration date
07/10/2014
Last updated
07/10/2014
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