Healthcare Provider Details

I. General information

NPI: 1730451543
Provider Name (Legal Business Name): ERIN WALLACE PHARM.D
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/09/2012
Last Update Date: 02/20/2024
Certification Date: 02/20/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

269 DILLON RIDGE RD
DILLON CO
80435-8801
US

IV. Provider business mailing address

PO BOX 1604
DILLON CO
80435-1583
US

V. Phone/Fax

Practice location:
  • Phone: 970-468-0287
  • Fax: 937-431-8672
Mailing address:
  • Phone: 970-468-0287
  • Fax: 970-468-7879

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number03125960-1
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: