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NPI Code Detail

MEDICARE: AUDREY C WALLACE RPH

MEDICARE: AUDREY C WALLACE RPH
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1183500000XPharmacist03440267OH
2183500000XPharmacist26029026AIN

General Provider Information

NPI Number : 1295339430
Entity Type Code : Individual
Provider Name (Legal Business Name) : AUDREY C WALLACE RPH
Provider Business Mailing Address
First Line : 1836 N 300 W
Second Line :
City : GREENFIELD
State : IN
Zip : 46140-8425
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 5026 W US HIGHWAY 52
Second Line :
City : NEW PALESTINE
State : IN
Zip : 46163-9770
Country : US
Telephone Number : 317-861-4838
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 11/29/2020
Last Update Date : 11/29/2020

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Directions to “ AUDREY C WALLACE RPH” Practice Location

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