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General NPI Number Information
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NPI Number | 1396880738
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Entity Type | Individual
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Provider Name | JOHN EDWARD WALL RPH
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Gender | Male
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Dates
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Enumeration Date | 02/21/2007
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 26317 W. WASHINGTON STREET EXTENDED
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City | PETERSBURG
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State | VA
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Zip | 23803-0030
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Country | US
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Telephone | 804-524-7657
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Fax |
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Provider Business Mailing Address
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Address Line | 11104 CONTINENTAL CT
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City | PETERSBURG
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State | VA
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Zip | 23805-9689
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Country | US
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Telephone |
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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 | 0202007843
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License Number State | VA
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