J Wallace LLC
Organization Active NPI Community/Retail Pharmacy · Williamstown, KY
NPI 1184728149 · NPPES record last updated May 2, 2025
Key facts
- NPI
- 1184728149
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Community/Retail Pharmacy 3336C0003X
- License
- PO6979 (KY)
- Legal business name
- J WALLACE LLC
- Practice address
- 302A Barnes Rd
Williamstown, KY 41097-9483 - Phone
- (859) 824-4239
- Fax
- (859) 824-2110
- NPI assigned
- Sep 12, 2006
- Organization subpart
- No
Authorized official
- Name
- Jason Wallace, PHARMD, RPH
- Title
- Owner
- Phone
- (859) 824-4239
Corporate family (same tax ID) 1
Laboratory certificates & supplier records
Medicare medical equipment & supply locations
| Supplier | Supplies | Medicare assignment |
|---|---|---|
| Grant County Drugs Williamstown |
Epoetin|Immunosuppressive Drugs|Infusion Drugs|Nebulizer Drugs|Oral Anticancer Drugs|Oral Antiemetic Drugs|Commodes, Urinals, Bedpans|Blood Glucose Monitors/Supplies (Non-Mail Order)|Heat & Cold Applications|Hospital Beds (Electric)|Hospital Beds (Manual)|Pneumatic Compression Devices and/or Suppli… | Accepts assignment |
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled (2 enrollments) in KY
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20100930017068 | KY | DME Supplier - Pharmacy |
3779794656 | Practice locations: Williamstown, KY |
| O20161109002549 | KY | Part B Supplier - Mass Immunization (Roster Biller Only) | 3779794656 | Practice locations: Crittenden, KY; Williamstown, KY |
National Provider Directory
- Tax ID family
- J Wallace LLC
Locations
375 Violet Rd
Ste A
Crittenden, KY 41030
Phone (859) 428-3784
302 Barnes Rd
#A
Williamstown, KY 41097
Phone (859) 824-4239
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Customized Equipment (DME) | 332BC3200X | P06979 | KY | |
| Community/Retail Pharmacy | 3336C0003X | PO6979 | KY | Yes |
Addresses
Primary practice location
302A Barnes Rd
Williamstown, KY 41097-9483
Mailing address
302 Barnes Rd
Williamstown, KY 41097-9483
Phone (859) 824-4239
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 54009139 | Medicaid | KY | |
| 90011560 | Medicaid | KY | |
| 2029150 | Other | PK |
Other names
- GRANT COUNTY DRUGS WILLIAMSTOWN
Other providers in Williamstown, KY
- Kristine Marie Gulley
- Amy Gutman
- Emily Hagedorn
- Mary Diane Hamm
- Alice Jeanne Heeger-Hartman
- Beth A Johnson
- Julia M. Kampsen
- Karen Kells
- Sharla Lake
- Karen S Levy
All providers in Williamstown, KY · Community/Retail Pharmacy in Kentucky
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on May 2, 2025. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.