Active NPI
Keith W Wallace, RPH
- Pharmacotherapy Pharmacist
- Millville, NJ
National Provider Identifier
1932483203
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pharmacotherapy Pharmacist
- License
- 28RI01730800
- Practice address
- 1111 N High St
Millville, NJ 08332-2528 - Phone
- (856) 293-9717
- Fax
- (856) 293-7980
- NPI assigned
- Oct 5, 2011
- Last updated
- Oct 5, 2011
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pharmacotherapy Pharmacist | 1835P1200X | 28RI01730800 | NJ | Primary |
Addresses
Primary practice location
1111 N High St
Millville, NJ 08332-2528
Mailing address
1111 N High St
Millville, NJ 08332-2528
Phone (856) 293-9717
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
- Registered Pharmacist
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 28RI01730800 | NJ | MD | Pharmacotherapy Pharmacist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Walgreen Co | Past | Accepting new patients | |
| Walgreen Co | Past | Accepting new patients |
Organizations & group practices 2
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.
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1317772800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1317772800000",
"number": "1932483203",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1111 N HIGH ST",
"city": "MILLVILLE",
"state": "NJ",
"postal_code": "083322528",
"telephone_number": "856-293-9717",
"fax_number": "856-293-7980"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1111 N HIGH ST",
"city": "MILLVILLE",
"state": "NJ",
"postal_code": "083322528",
"telephone_number": "856-293-9717",
"fax_number": "856-293-7980"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WALLACE",
"first_name": "KEITH",
"middle_name": "W",
"name_prefix": "Mr.",
"credential": "RPH",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2011-10-05",
"last_updated": "2011-10-05",
"status": "A"
},
"taxonomies": [
{
"code": "1835P1200X",
"taxonomy_group": "",
"desc": "Pharmacist, Pharmacotherapy",
"state": "NJ",
"license": "28RI01730800",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Millville, NJ
- Village Drive Healthcare Urban Renewal LLC
- Voca Corporation of New Jersey
- Wal-Mart Stores East LP (Wal-Mart Pharmacy 10-2109)
- Wal-Mart Stores East, L.P. (Vision Center 30-2109)
- Walgreen Co (Walgreens #06902)
- Bingyan Wang, D.O.
- Jennifer L Watson
- William West Jr.
- Westside Transportation
- Marilyn Jean Wheeler, COTA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 5, 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.