NPIMap

Individual provider Active NPI

Jacqueline Wallace

  • Pharmacist
  • Windsor, CO
National Provider Identifier
1518200740
Registry record updated Apr 6, 2013
On this page

Key facts

NPPES NPI Registry
Primary specialty
PharmacistTaxonomy code 183500000X
License
15631 Issued in CO
Practice address
1520 Main St
Windsor, CO 80550-7909
Phone
(970) 674-2840
Fax
(970) 674-2843
NPI assigned
Apr 6, 2013
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Apr 6, 2013

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Pharmacist 183500000X 15631 CO Primary

Addresses

Primary practice location

1520 Main St
Windsor, CO 80550-7909

Mailing address

1520 Main St
Windsor, CO 80550-7909
Phone (970) 674-2840

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

LicenseStateTypeSpecialty
15631COMDPharmacist

Practice roles

OrganizationSpecialtyStatusNew patients
Dillon Companies LLC Past Accepting new patients
Dillon Companies LLC Past Accepting new patients

Organizations & group practices 2

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.

NPI Registry JSON

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

{
    "created_epoch": "1365206400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1365206400000",
    "number": "1518200740",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1520 MAIN ST",
            "city": "WINDSOR",
            "state": "CO",
            "postal_code": "805507909",
            "telephone_number": "970-674-2840",
            "fax_number": "970-674-2843"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1520 MAIN ST",
            "city": "WINDSOR",
            "state": "CO",
            "postal_code": "805507909",
            "telephone_number": "970-674-2840",
            "fax_number": "970-674-2843"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WALLACE",
        "first_name": "JACQUELINE",
        "name_prefix": "Ms.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2013-04-06",
        "last_updated": "2013-04-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "183500000X",
            "taxonomy_group": "",
            "desc": "Pharmacist",
            "state": "CO",
            "license": "15631",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Windsor, CO

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 6, 2013; 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.