Jacqueline Rae Waller, PHARMD

Primary specialty

Ambulatory Care PharmacistTaxonomy code 1835P2201X

License

16773 Issued in NE

Practice address

8105 Veterans Way
Montgomery, AL 36117-3879

Phone

(308) 850-4306

NPI assigned

Feb 10, 2021

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Electronic endpoints 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Doctor of Pharmacy

State licenses

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

{
    "created_epoch": "1612915200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1612915200000",
    "number": "1891387809",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "701 TAYLOR OAKS CIR APT 305",
            "city": "MONTGOMERY",
            "state": "AL",
            "postal_code": "361168100",
            "telephone_number": "308-850-4306"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "8105 VETERANS WAY",
            "city": "MONTGOMERY",
            "state": "AL",
            "postal_code": "361173879",
            "telephone_number": "308-850-4306"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WALLER",
        "first_name": "JACQUELINE",
        "middle_name": "RAE",
        "credential": "PHARMD",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2021-02-10",
        "last_updated": "2021-02-10",
        "certification_date": "2021-02-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1835P2201X",
            "taxonomy_group": "",
            "desc": "Pharmacist, Ambulatory Care",
            "state": "NE",
            "license": "16773",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "jacqueline.waller@va.gov",
            "affiliation": "N",
            "endpointDescription": "VA Email",
            "address_1": "8105 Veterans Way",
            "city": "Montgomery",
            "state": "AL",
            "country_code": "US",
            "postal_code": "361173879",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Maci Wallace, PT
• Marilynn R. Wallace, PHARM.D.
• Mathew Cary Wallace, M.D.
• Takova Wallace, PHARMD
• Gregory Allen Waller, M.D.
• Wallers Transport Services LLC
• Cooper Walley, RN
• Lawrence A Wallin, MD
• Christopher L. Walsh, CRNA
• Enjolique Walters

• All providers in Montgomery, AL
• Ambulatory Care Pharmacist in Alabama

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 10, 2021; 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.