Individual
MR. BRENT WALLACE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
R.PH.
Contact information
Practice address
1661 HILLIARD ROME RD, COLUMBUS, OH 43228-9485
(614) 771-9200
(614) 529-5165
Mailing address
1661 HILLIARD ROME RD, COLUMBUS, OH 43228-9485
(614) 771-9200
(614) 529-5165
Taxonomy
Speciality
Code
Description
License number
State
183500000X
Pharmacist
Primary
03122556
OH
Other
Enumeration date
02/18/2014
Last updated
02/18/2014
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