Active NPI
Crystal Wallace
- Pharmacist
- Vineland, NJ
National Provider Identifier
1467724674
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pharmacist
- License
- 28RI03230900
- Practice address
- 1070 W Landis Ave
Vineland, NJ 08360-3422 - Phone
- (856) 205-9354
- NPI assigned
- Feb 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 | 28RI03230900 | NJ | Primary |
Addresses
Primary practice location
1070 W Landis Ave
Vineland, NJ 08360-3422
Mailing address
360 Cedarwood Dr
Vineland, NJ 08360-7710
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
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 28RI03230900 | NJ | MD | Pharmacist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1328140800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1328140800000",
"number": "1467724674",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "360 CEDARWOOD DR",
"city": "VINELAND",
"state": "NJ",
"postal_code": "083607710"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1070 W LANDIS AVE",
"city": "VINELAND",
"state": "NJ",
"postal_code": "083603422",
"telephone_number": "856-205-9354"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WALLACE",
"first_name": "CRYSTAL",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2012-02-02",
"last_updated": "2012-02-02",
"status": "A"
},
"taxonomies": [
{
"code": "183500000X",
"taxonomy_group": "",
"desc": "Pharmacist",
"state": "NJ",
"license": "28RI03230900",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Vineland, NJ
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 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.