Kole Wallace

Primary specialty

PharmacistTaxonomy code 183500000X

License

03439126 Issued in OH

Practice address

1009 Park Ave W
Mansfield, OH 44906-2809

Phone

(419) 525-7300

NPI assigned

Aug 21, 2019

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

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 and National Provider Directory roles.

• Rite Aid of Ohio Inc

  • Community/Retail Pharmacy
  • Mansfield, OH
  • NPI 1447369772
  NPD (past)

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

{
    "created_epoch": "1566345600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1566345600000",
    "number": "1760039192",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "426 CHEVY CHASE RD",
            "city": "MANSFIELD",
            "state": "OH",
            "postal_code": "449071547",
            "telephone_number": "937-573-7039"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1009 PARK AVE W",
            "city": "MANSFIELD",
            "state": "OH",
            "postal_code": "449062809",
            "telephone_number": "419-525-7300"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WALLACE",
        "first_name": "KOLE",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2019-08-21",
        "last_updated": "2019-08-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "183500000X",
            "taxonomy_group": "",
            "desc": "Pharmacist",
            "state": "OH",
            "license": "03439126",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Walgreens
• Angela Beth Walker, PTA
• Megan Walker, D.C.
• Melanie Nicole Walker, CDCA
• Crystalshae Leann Wallace
• Raisa Lepa Wallace
• Cynthia Ann Wallis, LISW
• Walter E Glenn DDS Inc
• Walter G. Bodjanac, DO, LLC
• Philip W. Walter, D.D.S.

• Pharmacist in Mansfield, OH
• Providers in Mansfield, OH by specialty
• Pharmacist in Ohio

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 21, 2019; 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.