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General NPI Number Information
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NPI Number | 1730926031
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Entity Type | Organization
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Legal Business Name | WALLYS CLINICAL SERVICES LLC
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Dates
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Enumeration Date | 07/12/2024
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Last Update Date | 08/19/2025
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Provider Practice Location Address
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Address Line | 933 ROCKFORD ST STE 5
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City | MOUNT AIRY
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State | NC
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Zip | 27030-5323
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Country | US
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Telephone | 336-466-4777
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Fax | 336-789-1161
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Provider Business Mailing Address
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Address Line | 933 ROCKFORD ST STE 5
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City | MOUNT AIRY
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State | NC
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Zip | 27030-5323
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Country | US
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Telephone | 336-466-4777
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Fax | 336-789-1161
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Authorized Official
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Title or Position | OWNER/AUTHORIZED OFFICIAL
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Name | JESSICA S SCOTT
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Credential | PHARMACIST
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Telephone | 336-466-4777
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 3336C0002X
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Taxonomy Name | Clinic Pharmacy
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 261QM1300X
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Taxonomy Name | Multi-Specialty Clinic/Center
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License Number |
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License Number State |
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