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General NPI Number Information
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NPI Number | 1437287943
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Entity Type | Individual
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Provider Name | JO LYNNE WALLIN-WAIS PHARM.D., BCPS
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Gender | Female
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Dates
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Enumeration Date | 02/28/2007
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 5701 N CHARLES ST SUITE 5218
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City | BALTIMORE
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State | MD
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Zip | 21210-1315
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Country | US
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Telephone | 443-849-3786
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Fax | 443-849-8447
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Provider Business Mailing Address
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Address Line | 2308 W ROGERS AVE
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City | BALTIMORE
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State | MD
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Zip | 21209-4426
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Country | US
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Telephone | 410-664-8717
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Fax | 443-849-3447
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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 | 1835P1200X
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Taxonomy Name | Pharmacotherapy Pharmacist
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License Number | 11560
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License Number State | MD
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