Stephanie Wallace, PHARMD

Primary specialty

Community/Retail PharmacyTaxonomy code 3336C0003X

License

0020679 Issued in CO

Practice address

815 Cheyenne Meadows Rd
Colorado Springs, CO 80906-4929

Phone

(719) 527-1640

NPI assigned

Feb 2, 2015

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 4

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

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Dillon Companies LLC

  • Community/Retail Pharmacy
  • Fountain, CO
  • NPI 1194524165
  NPD (past)
• Dillon Companies LLC

  • Community/Retail Pharmacy
  • Colorado Springs, CO
  • NPI 1407882756
  NPD (past)

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

{
    "created_epoch": "1422835200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1601856000000",
    "number": "1477943223",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "815 CHEYENNE MEADOWS RD",
            "city": "COLORADO SPRINGS",
            "state": "CO",
            "postal_code": "809064929",
            "telephone_number": "719-527-1640"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "815 CHEYENNE MEADOWS RD",
            "city": "COLORADO SPRINGS",
            "state": "CO",
            "postal_code": "809064929",
            "telephone_number": "719-527-1640"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WALLACE",
        "first_name": "STEPHANIE",
        "credential": "PHARMD",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2015-02-02",
        "last_updated": "2020-10-05",
        "certification_date": "2020-10-05",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "183500000X",
            "taxonomy_group": "",
            "desc": "Pharmacist",
            "state": "NY",
            "license": "058853",
            "primary": false
        },
        {
            "code": "183500000X",
            "taxonomy_group": "",
            "desc": "Pharmacist",
            "state": "TN",
            "license": "33624",
            "primary": false
        },
        {
            "code": "183500000X",
            "taxonomy_group": "",
            "desc": "Pharmacist",
            "state": "CO",
            "license": "0020679",
            "primary": false
        },
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": "CO",
            "license": "0020679",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Hazel Wallace
• Helene Wallace, LMT
• Mary Anderson Wallace, M.D.
• Richard Wallace, RN BSN
• Robert Wallace
• Stephanie R Wallace, MD
• Kristin Wallau, COTA/L
• Katlyn Walle
• Hannah Waller
• William W Waller, CPH, MHFA

• Community/Retail Pharmacy in Colorado Springs, CO
• Providers in Colorado Springs, CO by specialty
• Community/Retail Pharmacy in Colorado

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 5, 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.