Terrica Diane Wallace, PHARMD.

Primary specialty

PharmacistTaxonomy code 183500000X

License

PS52287 Issued in FL

Practice address

7546 103Rd St
Jacksonville, FL 32210-6713

Phone

(904) 777-3050

NPI assigned

Feb 28, 2015

Sex

Female

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

Doctor of Pharmacy

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.

• Walgreen Co

  • Pharmacy
  • Jacksonville, FL
  • NPI 1497762470
  NPD (past)
• Walgreen Co

  • Pharmacy
  • Longview, TX
  • NPI 1629956545
  NPD (past)

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

{
    "created_epoch": "1425081600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1425081600000",
    "number": "1972995934",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3928 VICTORIA LAKES DR S",
            "city": "JACKSONVILLE",
            "state": "FL",
            "postal_code": "322260709"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "7546 103RD ST",
            "city": "JACKSONVILLE",
            "state": "FL",
            "postal_code": "322106713",
            "telephone_number": "904-777-3050"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WALLACE",
        "first_name": "TERRICA",
        "middle_name": "DIANE",
        "name_prefix": "Miss",
        "credential": "PHARMD.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2015-02-28",
        "last_updated": "2015-02-28",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "183500000X",
            "taxonomy_group": "",
            "desc": "Pharmacist",
            "state": "FL",
            "license": "PS52287",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Patricia J Wallace, ARNP-BC
• Phillip Tyler Wallace, APRN
• Ricky Wallace
• Shanthalitta Seals Wallace, LMHC
• Taylor K Wallace, CNA
• Max Joseph Wallack
• Darci Waller
• John Waller
• Thomas Waller, MD
• Andrew Wallin, LMHC

• Pharmacist in Jacksonville, FL
• Providers in Jacksonville, FL by specialty
• Pharmacist in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 28, 2015; 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.