Dustin L Wallace, CPHT

Primary specialty

Pharmacy TechnicianTaxonomy code 183700000X

License

RPT57955 Issued in FL

Practice address

2 Shircliff Way Ste 900
Jacksonville, FL 32204-4753

Phone

(904) 389-9744

NPI assigned

Jan 27, 2021

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

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

{
    "created_epoch": "1611705600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1611705600000",
    "number": "1326639006",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2952 ROSSELLE ST",
            "city": "JACKSONVILLE",
            "state": "FL",
            "postal_code": "322055666",
            "telephone_number": "615-310-1217",
            "fax_number": "888-974-6157"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2 SHIRCLIFF WAY STE 900",
            "city": "JACKSONVILLE",
            "state": "FL",
            "postal_code": "322044753",
            "telephone_number": "904-389-9744"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WALLACE",
        "first_name": "DUSTIN",
        "middle_name": "L",
        "name_prefix": "Mr.",
        "credential": "CPHT",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2021-01-27",
        "last_updated": "2021-01-27",
        "certification_date": "2021-01-27",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "183700000X",
            "taxonomy_group": "",
            "desc": "Pharmacy Technician",
            "state": "FL",
            "license": "RPT57955",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PHARMACY TECH",
            "identifier": "RPT57955",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Terri Northup Wall, PH.D.
• Timothy E Wall, A.T.
• Angel Wallace
• Ari Wallace
• Bradley A Wallace, MD
• Elizabeth Roslyn Wallace, PHD
• Francheska Wallace, HOME HEALTH AIDE
• Ima Latoya Wallace
• Joyce Wallace, CRNA, ARNP
• Kristen Paula Wallace, PA

• Pharmacy Technician in Jacksonville, FL
• Providers in Jacksonville, FL by specialty
• Pharmacy Technician in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 27, 2021; 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.