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General NPI Number Information
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NPI Number | 1376529321
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Entity Type | Individual
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Provider Name | EMILY CARA WALLACE PHARMD
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Gender | Female
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Dates
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Enumeration Date | 12/21/2005
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Last Update Date | 12/31/2009
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Provider Practice Location Address
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Address Line | 34515 9TH AVE S
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City | FEDERAL WAY
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State | WA
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Zip | 98003-6761
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Country | US
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Telephone | 253-944-7966
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Fax |
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Provider Business Mailing Address
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Address Line | 1205 N SUNSET DR
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City | TACOMA
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State | WA
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Zip | 98406-1028
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Country | US
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Telephone | 253-752-2532
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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 | PH00056440
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License Number State | WA
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