John Mark Wallace, R.PH.

Primary specialty

PharmacistTaxonomy code 183500000X

License

3169351701 Issued in UT

Practice address

500 Foothill Blvd
Salt Lake City, UT 84148-0001

Phone

(801) 582-1565

Fax

(801) 584-2530

NPI assigned

Jul 12, 2006

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other names 1

• Mr. J. Mark Wallace Other name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Registered Pharmacist

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1152662400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1154356467",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1422 E 9090 S",
            "city": "SANDY",
            "state": "UT",
            "postal_code": "840932203",
            "telephone_number": "801-582-1565",
            "fax_number": "801-584-2530"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "500 FOOTHILL BLVD",
            "city": "SALT LAKE CITY",
            "state": "UT",
            "postal_code": "841480001",
            "telephone_number": "801-582-1565",
            "fax_number": "801-584-2530"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WALLACE",
        "first_name": "JOHN",
        "middle_name": "MARK",
        "name_prefix": "Mr.",
        "credential": "R.PH.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-07-12",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "183500000X",
            "taxonomy_group": "",
            "desc": "Pharmacist",
            "state": "UT",
            "license": "3169351701",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "J.",
            "last_name": "WALLACE",
            "middle_name": "MARK",
            "prefix": "MR.",
            "credential": "R.PH.",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

• Connor Wallace
• Diane Elizabeth Wallace, R.PH.
• Jacob Wallace
• James Michael Wallace, M.D.
• Jennifer Wallace
• Justice Kassidy Wallace
• Laney Wallace
• Mark Spangler Wallace, DDS
• Marshall W. Wallace, MD
• Rebecca Wallace, APRN

• Pharmacist in Salt Lake City, UT
• Providers in Salt Lake City, UT by specialty
• Pharmacist in Utah

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.