Individual
DR. TYSON WALLACE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PHARM. D.
Contact information
Practice address
134 BEVILL AVE, GOSNELL, AR 72315
(870) 751-9242
(870) 751-9291
Mailing address
134 BEVILL AVE, GOSNELL, AR 72315
(870) 751-9242
(870) 751-9291
Taxonomy
Speciality
Code
Description
License number
State
183500000X
Pharmacist
2007005629
MO
183500000X
Pharmacist
Primary
PD09924
AR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
289547795
—
AR
Enumeration date
02/11/2021
Last updated
04/22/2025
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