Emily Brooke Wallace, PHARM.D. CANDIDATE

Primary specialty

PharmacistTaxonomy code 183500000X

License

60302033 Issued in WA

Practice address

2290 NE Westwood Dr Apt H103
Pullman, WA 99163-5233

Phone

(406) 579-7205

NPI assigned

Feb 8, 2016

Sex

Female

Sole proprietor

No

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

Specialties & licenses 3

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 and National Provider Directory roles.

• Lee & Dads Grocery Inc

  • Pharmacy
  • Belgrade, MT
  • NPI 1518007731
  NPD Authorized official

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

{
    "created_epoch": "1454889600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1454889600000",
    "number": "1306204144",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2290 NE WESTWOOD DR APT H103",
            "city": "PULLMAN",
            "state": "WA",
            "postal_code": "991635233",
            "telephone_number": "406-579-7205"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2290 NE WESTWOOD DR APT H103",
            "city": "PULLMAN",
            "state": "WA",
            "postal_code": "991635233",
            "telephone_number": "406-579-7205"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WALLACE",
        "first_name": "EMILY",
        "middle_name": "BROOKE",
        "credential": "PHARM.D. CANDIDATE",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2016-02-08",
        "last_updated": "2016-02-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "183500000X",
            "taxonomy_group": "",
            "desc": "Pharmacist",
            "state": "WA",
            "license": "60302033",
            "primary": true
        },
        {
            "code": "183500000X",
            "taxonomy_group": "",
            "desc": "Pharmacist",
            "state": "ID",
            "license": "E34399",
            "primary": false
        },
        {
            "code": "183500000X",
            "taxonomy_group": "",
            "desc": "Pharmacist",
            "state": "MT",
            "license": "PHA-PIN-LIC-15878",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Lenora Marie Waelti, PT
• Wal-Mart Stores Inc
• Abigail Waldo, ATC
• Matthew Walker, OD
• Jennifer Wall, COTA
• Ian Wallace, MS, CGC
• Gregory Wallis, DO
• Walmart Inc.
• Cameron Walsworth
• Jeffrey Loren Ward, DO

• All providers in Pullman, WA
• Pharmacist in Washington

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 8, 2016; 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.