William Lee Wallace

Primary specialty

PharmacistTaxonomy code 183500000X

License

PH07329 Issued in AR

Practice address

308 S Main St
Malvern, AR 72104-3737

Phone

(501) 467-8197

Fax

(501) 467-8662

NPI assigned

Aug 22, 2020

Last updated

Aug 22, 2020By the provider in NPPES

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Electronic endpoints 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

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

{
    "created_epoch": "1598054400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1598054400000",
    "number": "1528670361",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "308 S MAIN ST",
            "city": "MALVERN",
            "state": "AR",
            "postal_code": "721043737",
            "telephone_number": "501-467-8197",
            "fax_number": "501-467-8662"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "308 S MAIN ST",
            "city": "MALVERN",
            "state": "AR",
            "postal_code": "721043737",
            "telephone_number": "501-467-8197",
            "fax_number": "501-467-8662"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WALLACE",
        "first_name": "WILLIAM",
        "middle_name": "LEE",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2020-08-22",
        "last_updated": "2020-08-22",
        "certification_date": "2020-08-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "183500000X",
            "taxonomy_group": "",
            "desc": "Pharmacist",
            "state": "AR",
            "license": "PH07329",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "rxm.10365@store.walgreens.com",
            "affiliation": "N",
            "endpointDescription": "email",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "CSV",
            "contentTypeDescription": "CSV",
            "address_1": "944 Round Hill Rd",
            "city": "Leola",
            "state": "AR",
            "country_code": "US",
            "postal_code": "720848963",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

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• Pharmacist in Malvern, AR
• Providers in Malvern, AR by specialty
• Pharmacist in Arkansas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 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.