Active NPI
Brennen Wallace
- Pharmacist
- Zanesville, OH
National Provider Identifier
1013512318
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pharmacist
- License
- 03337054
- Practice address
- 103 N Maysville Ave
Zanesville, OH 43701-6184 - Phone
- (740) 452-7589
- NPI assigned
- Dec 3, 2020
- 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 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pharmacist | 183500000X | 03337054 | OH | Primary |
Addresses
Primary practice location
103 N Maysville Ave
Zanesville, OH 43701-6184
Mailing address
103 N Maysville Ave
Zanesville, OH 43701-6184
Phone (740) 452-7589
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
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 03337054 | OH | MD | Pharmacist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1606953600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1606953600000",
"number": "1013512318",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "103 N MAYSVILLE AVE",
"city": "ZANESVILLE",
"state": "OH",
"postal_code": "437016184",
"telephone_number": "740-452-7589"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "103 N MAYSVILLE AVE",
"city": "ZANESVILLE",
"state": "OH",
"postal_code": "437016184",
"telephone_number": "740-452-7589"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WALLACE",
"first_name": "BRENNEN",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2020-12-03",
"last_updated": "2020-12-03",
"certification_date": "2020-12-03",
"status": "A"
},
"taxonomies": [
{
"code": "183500000X",
"taxonomy_group": "",
"desc": "Pharmacist",
"state": "OH",
"license": "03337054",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Zanesville, OH
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 3, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.