David C. Wallace, R.PH.
Individual provider Active NPI Pharmacist · Creve Coeur, MO
NPI 1376667964 · NPPES record last updated Jul 8, 2007
Key facts
- NPI
- 1376667964
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Pharmacist 183500000X
- License
- PH044996 (MO)
- Practice address
- 621 S New Ballas Rd
Creve Coeur, MO 63141-8232 - Phone
- (314) 251-7444
- Fax
- (314) 251-7443
- NPI assigned
- Mar 19, 2007
- Sex
- Male
- Sole proprietor
- Yes
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
- Credentials
- Registered Pharmacist
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| PH044996 | MO | MD | Pharmacist |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pharmacist | 183500000X | PH044996 | MO | Yes |
Addresses
Primary practice location
621 S New Ballas Rd
Creve Coeur, MO 63141-8232
Mailing address
817 Brockwell Dr
Dardenne Prairie, MO 63368-8373
Other providers in Creve Coeur, MO
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jul 8, 2007. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.