Individual
DR. MICHELLE WALLACE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PHARMD
Contact information
Practice address
3785 W INA RD, TUCSON, AZ 85741-2247
(520) 744-1054
Mailing address
3785 W INA RD, TUCSON, AZ 85741-2247
(520) 744-1054
Taxonomy
Speciality
Code
Description
License number
State
183500000X
Pharmacist
Primary
S026695
AZ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
S026695
ARIZONA STATE BOARD OF PHARMACY
AZ
Enumeration date
09/21/2023
Last updated
09/21/2023
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