Individual
MELISSA WALLACE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
RPH
Contact information
Practice address
40017 LA-42, PRAIRIEVILLE, LA 70769
(225) 300-6080
Mailing address
43121 BEACON LN, PRAIRIEVILLE, LA 70769-5266
(225) 253-5884
Taxonomy
Speciality
Code
Description
License number
State
183500000X
Pharmacist
Primary
PST.018016
LA
Other
Enumeration date
04/07/2021
Last updated
04/07/2021
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