Active NPI
Donna C. Wallace, PHARMD
- Pharmacist
- Pembroke Pines, FL
National Provider Identifier
1164938130
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pharmacist
- License
- PS30769
- Practice address
- 1817 NW 127TH Ave
Pembroke Pines, FL 33028-2567 - Phone
- (954) 325-1495
- NPI assigned
- Dec 28, 2017
- Sex
- Female
- Sole proprietor
- Yes
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 |
|---|---|---|---|---|
| Ambulatory Care Pharmacist | 1835P2201X | PU4665 | FL | |
| Pharmacist | 183500000X | PS30769 | FL | Primary |
Addresses
Primary practice location
1817 NW 127TH Ave
Pembroke Pines, FL 33028-2567
Mailing address
1817 NW 127TH Ave
Pembroke Pines, FL 33028-2567
Phone (954) 325-1495
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 |
|---|---|---|---|
| PS30769 | FL | MD | Pharmacist |
| PU4665 | FL | MD | Ambulatory Care Pharmacist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1514419200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1514419200000",
"number": "1164938130",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1817 NW 127TH AVE",
"city": "PEMBROKE PINES",
"state": "FL",
"postal_code": "330282567",
"telephone_number": "954-325-1495"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1817 NW 127TH AVE",
"city": "PEMBROKE PINES",
"state": "FL",
"postal_code": "330282567",
"telephone_number": "954-325-1495"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WALLACE",
"first_name": "DONNA",
"middle_name": "C.",
"name_prefix": "Mrs.",
"credential": "PHARMD",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2017-12-28",
"last_updated": "2017-12-28",
"status": "A"
},
"taxonomies": [
{
"code": "1835P2201X",
"taxonomy_group": "",
"desc": "Pharmacist, Ambulatory Care",
"state": "FL",
"license": "PU4665",
"primary": false
},
{
"code": "183500000X",
"taxonomy_group": "193400000X SINGLE SPECIALTY GROUP",
"desc": "Pharmacist",
"state": "FL",
"license": "PS30769",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Pembroke Pines, FL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 28, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.