Active NPI
Kristie Jackson Wallace, PHARMD
- Pharmacotherapy Pharmacist
- St Petersburg, FL
National Provider Identifier
1154324861
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pharmacotherapy Pharmacist
- License
- PS27159
- Practice address
- 499 Laguna Dr
St Petersburg, FL 33715-1842 - Phone
- (727) 542-1340
- Fax
- (727) 865-6040
- NPI assigned
- May 27, 2005
- 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 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pharmacotherapy Pharmacist | 1835P1200X | PS27159 | FL | Primary |
Addresses
Primary practice location
499 Laguna Dr
St Petersburg, FL 33715-1842
Mailing address
585 Capri Blvd
Treasure Island, FL 33706-2943
Phone (727) 363-4135
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 |
|---|---|---|---|
| PS27159 | FL | MD | Pharmacotherapy Pharmacist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1117152000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1783900800000",
"number": "1154324861",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "585 CAPRI BLVD",
"city": "TREASURE ISLAND",
"state": "FL",
"postal_code": "337062943",
"telephone_number": "727-363-4135"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "499 LAGUNA DR",
"city": "ST PETERSBURG",
"state": "FL",
"postal_code": "337151842",
"telephone_number": "727-542-1340",
"fax_number": "727-865-6040"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WALLACE",
"first_name": "KRISTIE",
"middle_name": "JACKSON",
"name_prefix": "Dr.",
"credential": "PHARMD",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2005-05-27",
"last_updated": "2026-07-13",
"status": "A"
},
"taxonomies": [
{
"code": "1835P1200X",
"taxonomy_group": "",
"desc": "Pharmacist, Pharmacotherapy",
"state": "FL",
"license": "PS27159",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in St Petersburg, FL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 13, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.