MEDICARE: MR. DAVID C. WALLACE R.PH.

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
1	183500000X	Pharmacist	PH044996	MO

General Provider Information

NPI Number	:	1376667964
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. DAVID C. WALLACE R.PH.

Provider Business Mailing Address
First Line	:	817 BROCKWELL DR
Second Line	:
City	:	DARDENNE PRAIRIE
State	:	MO
Zip	:	63368-8373
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	621 S NEW BALLAS RD
Second Line	:
City	:	CREVE COEUR
State	:	MO
Zip	:	63141-8232
Country	:	US
Telephone Number	:	314-251-7444
Fax Number	:	314-251-7443

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/19/2007
Last Update Date	:	07/08/2007

Similar Medicare Providers

1740398593 — DR. LISA S. ETZWILER M.D.
Practice Location Address:

621 S NEW BALLAS RD , ST. JOHN'S MERCY MEDICAL CENTER, SUITE 6006, TOWER B
CREVE COEUR, MO
63141-8232

Practice Phone: 314-251-6299
Practice Fax: 314-251-4450

1518069087 — DR. DENNIS J KEITHLY MD
Practice Location Address:

621 S NEW BALLAS RD
CREVE COEUR, MO
63141-8232

Practice Phone: 314-251-6816
Practice Fax:

1275696866 — DR. THAO TRAN MARQUEZ MD,MS
Practice Location Address:

621 S NEW BALLAS RD , SUITE 7011B
CREVE COEUR, MO
63141-8232

Practice Phone: 314-251-6840
Practice Fax:

1750591053 — DAVID EDWARD TANNEHILL D.O.
Practice Location Address:

621 S NEW BALLAS RD
CREVE COEUR, MO
63141-8232

Practice Phone: 314-251-5834
Practice Fax:

1114114691 — CHILDRENS ENDOCRINE CARE OF ST. LOUIS, LLC
Practice Location Address:

621 S NEW BALLAS RD , SUITE 3002 B
CREVE COEUR, MO
63141-8232

Practice Phone: 314-251-3002
Practice Fax:

1306076120 — MIKAEL GARRI MD
Practice Location Address:

621 S NEW BALLAS RD , SUITE 3016B
CREVE COEUR, MO
63141-8232

Practice Phone: 314-251-6339
Practice Fax: 314-251-4564

Directions to “ MR. DAVID C. WALLACE R.PH.” Practice Location

Language	Start Address	Practice Location

These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

Copyright © 2007-2025 (Powered by Swiss Vault Engine), all rights reserved. HIPAA liability, trademark, document use and software licensing rules apply. All registered trademarks, used in the content, are the property of their owners. Your interactions with this site are in accordance with our Terms of Use and Privacy Policy.