Keith Alan Wallace, BS PHARM

Primary specialty

PharmacistTaxonomy code 183500000X

License

2001019315 Issued in MO

Practice address

11643 Lilburn Park Rd
Saint Louis, MO 63146-3535

Phone

(314) 995-6843

Fax

(888) 916-0877

NPI assigned

Mar 23, 2007

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

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Bachelor of Science, Doctor of Pharmacy

State licenses

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

{
    "created_epoch": "1174608000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1294963200000",
    "number": "1750408795",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5 WOODLAND RIDGE CT",
            "city": "SAINT PETERS",
            "state": "MO",
            "postal_code": "633761788",
            "telephone_number": "636-240-0665"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "11643 LILBURN PARK RD",
            "city": "SAINT LOUIS",
            "state": "MO",
            "postal_code": "631463535",
            "telephone_number": "314-995-6843",
            "fax_number": "888-916-0877"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WALLACE",
        "first_name": "KEITH",
        "middle_name": "ALAN",
        "credential": "BS PHARM",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-03-23",
        "last_updated": "2011-01-14",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "183500000X",
            "taxonomy_group": "",
            "desc": "Pharmacist",
            "state": "MO",
            "license": "2001019315",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Jacob Henry Wallace, MD
• James Wallace, MA, THM, STM
• Jorge Wallace, PLPC
• Joslyn Wallace
• Kaila Wallace, DOULA
• Kelly A Wallace, CRNA
• Keri Renhui Wallace, MD
• Laura Ann Wallace, MD
• Lawanda Wallace
• Lisa Wallace, DO

• Pharmacist in Saint Louis, MO
• Providers in Saint Louis, MO by specialty
• Pharmacist in Missouri

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 14, 2011; 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.