Sandra Marie Wallace, PHARM.D.

Primary specialty

PharmacistTaxonomy code 183500000X

License

012689 Issued in KY

Practice address

4501 Outer Loop
Louisville, KY 40219-3856

Phone

(502) 969-2837

Fax

(502) 969-2856

NPI assigned

Jul 7, 2006

Last updated

Sep 4, 2007By the provider in NPPES

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Kroger Limited Partnership I

  dba Kroger Pharmacy

  • Community/Retail Pharmacy
  • Louisville, KY
  • NPI 1386678100
  NPD (past)

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

{
    "created_epoch": "1152230400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1188864000000",
    "number": "1710910617",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "205 TERRY DR",
            "city": "SHEPHERDSVILLE",
            "state": "KY",
            "postal_code": "401657814",
            "telephone_number": "502-543-9089"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4501 OUTER LOOP",
            "city": "LOUISVILLE",
            "state": "KY",
            "postal_code": "402193856",
            "telephone_number": "502-969-2837",
            "fax_number": "502-969-2856"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WALLACE",
        "first_name": "SANDRA",
        "middle_name": "MARIE",
        "name_prefix": "Dr.",
        "credential": "PHARM.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-07-07",
        "last_updated": "2007-09-04",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "183500000X",
            "taxonomy_group": "",
            "desc": "Pharmacist",
            "state": "KY",
            "license": "012689",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Elizabeth Keller Wallace, MA, CFY-SLP
• Kali Wallace, APRN
• Kiara Learlene Wallace, MD
• Melissa Wallace
• Rachel Wallace, NP
• Sara Wallace, LPA
• Shermeka Wallace
• Stephanie P Wallace, APRN
• Whitney R Wallace, COTA
• Robert John Wallander Jr., BCBA-D

• Pharmacist in Louisville, KY
• Providers in Louisville, KY by specialty
• Pharmacist in Kentucky

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 4, 2007; 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.