Jack Browning Wallace, PHARM. D

Primary specialty

PharmacistTaxonomy code 183500000X

License

33200 Issued in CA

Practice address

901 Soquel Ave
Santa Cruz, CA 95062-2122

Phone

(831) 426-4303

NPI assigned

Jun 14, 2011

Last updated

Jun 14, 2011By the provider in NPPES

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Doctor of Pharmacy

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Thrifty Payless Inc

  dba Rite Aid Pharmacy 06833

  • Community/Retail Pharmacy
  • Winchester, CA
  • NPI 1437874062
  NPD (past)
• Thrifty Payless Inc

  dba Rite Aid Pharmacy 05979

  • Community/Retail Pharmacy
  • Santa Cruz, CA
  • NPI 1457460982
  NPD (past)

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

{
    "created_epoch": "1308009600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1308009600000",
    "number": "1235424516",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "151 STEPHEN RD APT B",
            "city": "APTOS",
            "state": "CA",
            "postal_code": "950034667",
            "telephone_number": "831-332-9593"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "901 SOQUEL AVE",
            "city": "SANTA CRUZ",
            "state": "CA",
            "postal_code": "950622122",
            "telephone_number": "831-426-4303"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WALLACE",
        "first_name": "JACK",
        "middle_name": "BROWNING",
        "name_prefix": "Dr.",
        "credential": "PHARM. D",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2011-06-14",
        "last_updated": "2011-06-14",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "183500000X",
            "taxonomy_group": "",
            "desc": "Pharmacist",
            "state": "CA",
            "license": "33200",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Jordan Walker
• Margaret Vivien Walker
• Raelene Walker, M.D.
• Susan Walker
• David M Wall, MPA, PA-C
• Jefferey Wallace
• Kieran Wallace
• Susan Lee Wallace, LCSW
• Deborah Waller, OT
• Marissa Catherine Walls

• Pharmacist in Santa Cruz, CA
• Providers in Santa Cruz, CA by specialty
• Pharmacist in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 14, 2011; 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.