Active NPI
Victoria L Wallace, PHARMD
- Pharmacist
- Payette, ID
National Provider Identifier
1811279268
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pharmacist
- License
- P5339
- Practice address
- 405 S 8TH Street
Payette, ID 83661 - Phone
- (208) 642-9331
- NPI assigned
- Sep 12, 2011
- Last updated
- Sep 12, 2011
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pharmacist | 183500000X | P5339 | ID | Primary |
| Pharmacist | 183500000X | RPH0009655 | OR |
Addresses
Primary practice location
405 S 8TH Street
Payette, ID 83661
Mailing address
2726 S Montauk Ave
Boise, ID 83709-3300
Phone (208) 890-6988
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 |
|---|---|---|---|
| P5339 | ID | MD | Pharmacist |
| RPH0009655 | OR | MD | Pharmacist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1315785600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1315785600000",
"number": "1811279268",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2726 S MONTAUK AVE",
"city": "BOISE",
"state": "ID",
"postal_code": "837093300",
"telephone_number": "208-890-6988"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "405 S 8TH STREET",
"city": "PAYETTE",
"state": "ID",
"postal_code": "83661",
"telephone_number": "208-642-9331"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WALLACE",
"first_name": "VICTORIA",
"middle_name": "L",
"name_prefix": "Dr.",
"credential": "PHARMD",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2011-09-12",
"last_updated": "2011-09-12",
"status": "A"
},
"taxonomies": [
{
"code": "183500000X",
"taxonomy_group": "",
"desc": "Pharmacist",
"state": "ID",
"license": "P5339",
"primary": true
},
{
"code": "183500000X",
"taxonomy_group": "",
"desc": "Pharmacist",
"state": "OR",
"license": "RPH0009655",
"primary": false
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Payette, ID
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 12, 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.