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General NPI Number Information
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NPI Number | 1215892526
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Entity Type | Individual
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Provider Name | CARA LYNEE WALLACE RPH
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Gender | Female
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Dates
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Enumeration Date | 12/18/2025
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Last Update Date | 12/18/2025
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Provider Practice Location Address
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Address Line | 100 JASON DR
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City | TROY
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State | MO
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Zip | 63379-1944
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Country | US
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Telephone | 636-462-5901
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Fax | 636-462-5902
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Provider Business Mailing Address
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Address Line | 333 N 30TH ST
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City | LOUISIANA
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State | MO
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Zip | 63353-2507
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Country | US
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Telephone | 636-357-8423
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 183500000X
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Taxonomy Name | Pharmacist
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License Number | 044711
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License Number State | MO
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