Active NPI
Renee Wallace, PHARMD
- Pharmacist
- Kirkwood, MO
National Provider Identifier
1376899716
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pharmacist
- License
- 2012026473
- Practice address
- 1046 S Kirkwood Rd
T-1279
Kirkwood, MO 63122-7200 - Phone
- (314) 822-4051
- NPI assigned
- Aug 2, 2012
- Sex
- Female
- Sole proprietor
- Yes
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 | 2012026473 | MO | Primary |
Addresses
Primary practice location
1046 S Kirkwood Rd
T-1279
Kirkwood, MO 63122-7200
Mailing address
1046 S Kirkwood Rd
T-1279
Kirkwood, MO 63122-7200
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 |
|---|---|---|---|
| 2012026473 | MO | MD | Pharmacist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1343865600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1343865600000",
"number": "1376899716",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1046 S KIRKWOOD RD",
"address_2": "T-1279",
"city": "KIRKWOOD",
"state": "MO",
"postal_code": "631227200"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1046 S KIRKWOOD RD",
"address_2": "T-1279",
"city": "KIRKWOOD",
"state": "MO",
"postal_code": "631227200",
"telephone_number": "314-822-4051"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WALLACE",
"first_name": "RENEE",
"credential": "PHARMD",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2012-08-02",
"last_updated": "2012-08-02",
"status": "A"
},
"taxonomies": [
{
"code": "183500000X",
"taxonomy_group": "",
"desc": "Pharmacist",
"state": "MO",
"license": "2012026473",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Kirkwood, MO
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 2, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.