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General NPI Number Information
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NPI Number | 1003172792
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Entity Type | Organization
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Legal Business Name | DALLAS EXPRESS PHARMACY
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Dates
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Enumeration Date | 04/06/2012
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Last Update Date | 09/21/2021
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Provider Practice Location Address
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Address Line | 111A N HOFFMAN ST
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City | DALLAS
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State | NC
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Zip | 28034-1597
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Country | US
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Telephone | 704-922-3001
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Fax | 704-922-0060
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Provider Business Mailing Address
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Address Line | 111A N HOFFMAN ST
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City | DALLAS
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State | NC
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Zip | 28034-1597
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Country | US
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Telephone | 704-922-3001
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Fax | 704-922-0060
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Authorized Official
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Title or Position | PRESIDENT
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Name | MR. JACOB TYLER WALLACE JR.
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Credential |
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Telephone | 704-922-3001
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 3336C0003X
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Taxonomy Name | Community/Retail Pharmacy
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License Number | 09048
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License Number State | NC
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