Active NPI
Anita L Wallace, PHARM.D., CGP
- Pharmacist
- Manchester, NH
National Provider Identifier
1245324714
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pharmacist
- License
- 0000010344
- Practice address
- Manchester VA Medical Center
718 Smyth Road
Manchester, NH 03110 - Phone
- (603) 624-4366
- NPI assigned
- Oct 2, 2006
- 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 |
|---|---|---|---|---|
| Pharmacist | 183500000X | 0000010344 | TN | Primary |
Addresses
Primary practice location
Manchester VA Medical Center
718 Smyth Road
Manchester, NH 03110
Mailing address
38 Hawthorne Dr
F-303
Bedford, NH 03110-6895
Phone (603) 703-3660
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 |
|---|---|---|---|
| 0000010344 | TN | MD | Pharmacist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1159747200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1185753600000",
"number": "1245324714",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "38 HAWTHORNE DR",
"address_2": "F-303",
"city": "BEDFORD",
"state": "NH",
"postal_code": "031106895",
"telephone_number": "603-703-3660"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "MANCHESTER VA MEDICAL CENTER",
"address_2": "718 SMYTH ROAD",
"city": "MANCHESTER",
"state": "NH",
"postal_code": "03110",
"telephone_number": "603-624-4366"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WALLACE",
"first_name": "ANITA",
"middle_name": "L",
"name_prefix": "Dr.",
"credential": "PHARM.D., CGP",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2006-10-02",
"last_updated": "2007-07-30",
"status": "A"
},
"taxonomies": [
{
"code": "183500000X",
"taxonomy_group": "",
"desc": "Pharmacist",
"state": "TN",
"license": "0000010344",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Manchester, NH
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 30, 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.