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General NPI Number Information
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NPI Number | 1467510891
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Entity Type | Organization
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Legal Business Name | WALLIS ENTERPRISES INC
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Dates
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Enumeration Date | 12/05/2006
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Last Update Date | 09/18/2008
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Provider Practice Location Address
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Address Line | 2140 N MAIN ST
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City | LAS CRUCES
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State | NM
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Zip | 88001-1129
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Country | US
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Telephone | 505-524-2863
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Fax | 505-525-3192
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Provider Business Mailing Address
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Address Line | 2140 N MAIN ST
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City | LAS CRUCES
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State | NM
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Zip | 88001-1129
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Country | US
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Telephone | 505-524-2863
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Fax | 505-525-3192
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Authorized Official
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Title or Position | PRESIDENT
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Name | SCOTT W WALLIS
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Credential | R. PH.
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Telephone | 505-524-2863
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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 | PH00001546
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License Number State | NM
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