Active NPI
Joanna Theresa Wallace, PHARMD
- Pharmacist
- Middletown, NY
National Provider Identifier
1093117988
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pharmacist
- License
- 059150
- Practice address
- 280 Route 211 E
Suite 112
Middletown, NY 10940-3109 - Phone
- (845) 341-2700
- Fax
- (845) 402-7039
- NPI assigned
- Sep 23, 2014
- Sex
- Female
- 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 | PH234197 | MA | |
| Pharmacist | 183500000X | 059150 | NY | Primary |
Addresses
Primary practice location
280 Route 211 E
Suite 112
Middletown, NY 10940-3109
Mailing address
280 Route 211 E
Suite 112
Middletown, NY 10940-3109
Phone (845) 341-2700
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 |
|---|---|---|---|
| PH234197 | MA | MD | Pharmacist |
| 059150 | NY | MD | Pharmacist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Hudson Regional LTC Pharmacy Inc | Past | Accepting new patients | |
| Middletown LTC Pharmacy LLC | Past | Accepting new patients |
Organizations & group practices 2
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.
-
- Long Term Care Pharmacy
- Middletown, NY
- NPI 1548567225
-
- Long Term Care Pharmacy
- Middletown, NY
- NPI 1063869238
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1411430400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1411430400000",
"number": "1093117988",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "280 ROUTE 211 E",
"address_2": "SUITE 112",
"city": "MIDDLETOWN",
"state": "NY",
"postal_code": "109403109",
"telephone_number": "845-341-2700",
"fax_number": "845-402-7039"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "280 ROUTE 211 E",
"address_2": "SUITE 112",
"city": "MIDDLETOWN",
"state": "NY",
"postal_code": "109403109",
"telephone_number": "845-341-2700",
"fax_number": "845-402-7039"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WALLACE",
"first_name": "JOANNA",
"middle_name": "THERESA",
"name_prefix": "Dr.",
"credential": "PHARMD",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2014-09-23",
"last_updated": "2014-09-23",
"status": "A"
},
"taxonomies": [
{
"code": "183500000X",
"taxonomy_group": "",
"desc": "Pharmacist",
"state": "MA",
"license": "PH234197",
"primary": false
},
{
"code": "183500000X",
"taxonomy_group": "",
"desc": "Pharmacist",
"state": "NY",
"license": "059150",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Middletown, NY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 23, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.