Active NPI
Jay William Wallace, PHARM. D.
- Geriatric Pharmacist
- Tallahassee, FL
National Provider Identifier
1659742716
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Geriatric Pharmacist
- License
- PS28349
- Practice address
- 1616 Physicians Dr
Tallahassee, FL 32308-4619 - Phone
- (850) 431-5154
- NPI assigned
- Oct 15, 2015
- Sex
- Male
- Sole proprietor
- No
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 |
|---|---|---|---|---|
| Geriatric Pharmacist | 1835G0303X | PS28349 | FL | Primary |
Addresses
Primary practice location
1616 Physicians Dr
Tallahassee, FL 32308-4619
Mailing address
1616 Physicians Dr
Tallahassee, FL 32308-4619
Phone (850) 431-5154
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 |
|---|---|---|---|
| PS28349 | FL | MD | Geriatric Pharmacist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1444867200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1444867200000",
"number": "1659742716",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1616 PHYSICIANS DR",
"city": "TALLAHASSEE",
"state": "FL",
"postal_code": "323084619",
"telephone_number": "850-431-5154"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1616 PHYSICIANS DR",
"city": "TALLAHASSEE",
"state": "FL",
"postal_code": "323084619",
"telephone_number": "850-431-5154"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WALLACE",
"first_name": "JAY",
"middle_name": "WILLIAM",
"name_prefix": "Dr.",
"credential": "PHARM. D.",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2015-10-15",
"last_updated": "2015-10-15",
"status": "A"
},
"taxonomies": [
{
"code": "1835G0303X",
"taxonomy_group": "",
"desc": "Pharmacist, Geriatric",
"state": "FL",
"license": "PS28349",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Tallahassee, FL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 15, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.