Thomas E Wallace III, PHARMD

Primary specialty

PharmacistTaxonomy code 183500000X

License

PCT.0015303 Issued in CT

Practice address

1571 Forest Ave
Staten Island, NY 10302-2226

Phone

(718) 720-5604

NPI assigned

Oct 28, 2020

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

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

{
    "created_epoch": "1603843200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1603843200000",
    "number": "1316547342",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "616 BEMENT AVE",
            "city": "STATEN ISLAND",
            "state": "NY",
            "postal_code": "103102938",
            "telephone_number": "917-932-4257"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1571 FOREST AVE",
            "city": "STATEN ISLAND",
            "state": "NY",
            "postal_code": "103022226",
            "telephone_number": "718-720-5604"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WALLACE",
        "first_name": "THOMAS",
        "middle_name": "E",
        "name_prefix": "Dr.",
        "name_suffix": "III",
        "credential": "PHARMD",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2020-10-28",
        "last_updated": "2020-10-28",
        "certification_date": "2020-10-28",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "183500000X",
            "taxonomy_group": "",
            "desc": "Pharmacist",
            "state": "CT",
            "license": "PCT.0015303",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Jessica Wallace
• Jessica Lorraine Wallace, PA
• Kevin Gary Wallace, PHARMD.
• Leonarda Wallace, OTR/L
• Michael Wallace II
• Edward S Wallach, LCSW, PH.D.
• Stefanie Wallin
• Kathleen Walsh-Hoey, MA, CCC-SLP
• Christina Marie Walsh, PHARMD
• Deborah Marie Walsh, M.S. CCC-SLP

• Pharmacist in Staten Island, NY
• Providers in Staten Island, NY by specialty
• Pharmacist in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 28, 2020; 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.