Active NPI
Micah Jordan Wallace, PHARM.D.
- Pharmacist
- Charleston, SC
National Provider Identifier
1003241571
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pharmacist
- License
- 14060
- Practice address
- 2152 Savannah Hwy
Charleston, SC 29414-5311 - Phone
- (843) 556-8974
- NPI assigned
- Sep 3, 2013
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pharmacist | 183500000X | 14060 | SC | Primary |
| Pharmacist | 183500000X | 36630 | TN |
Addresses
Primary practice location
2152 Savannah Hwy
Charleston, SC 29414-5311
Mailing address
2152 Savannah Hwy
Charleston, SC 29414-5311
Phone (843) 556-8974
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Doctor of Pharmacy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 14060 | SC | MD | Pharmacist |
| 36630 | TN | MD | Pharmacist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1378166400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1378166400000",
"number": "1003241571",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2152 SAVANNAH HWY",
"city": "CHARLESTON",
"state": "SC",
"postal_code": "294145311",
"telephone_number": "843-556-8974"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2152 SAVANNAH HWY",
"city": "CHARLESTON",
"state": "SC",
"postal_code": "294145311",
"telephone_number": "843-556-8974"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WALLACE",
"first_name": "MICAH",
"middle_name": "JORDAN",
"name_prefix": "Dr.",
"credential": "PHARM.D.",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2013-09-03",
"last_updated": "2013-09-03",
"status": "A"
},
"taxonomies": [
{
"code": "183500000X",
"taxonomy_group": "",
"desc": "Pharmacist",
"state": "SC",
"license": "14060",
"primary": true
},
{
"code": "183500000X",
"taxonomy_group": "",
"desc": "Pharmacist",
"state": "TN",
"license": "36630",
"primary": false
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Charleston, SC
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 3, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.