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General NPI Number Information
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NPI Number | 1831840420
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Entity Type | Individual
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Provider Name | WALLACE MCLAURIN JR. PHARMD
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Gender | Male
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Dates
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Enumeration Date | 01/14/2022
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Last Update Date | 01/14/2022
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Provider Practice Location Address
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Address Line | 4910 I 55 N
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City | JACKSON
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State | MS
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Zip | 39211-5401
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Country | US
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Telephone | 601-366-6554
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Fax |
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Provider Business Mailing Address
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Address Line | 408 CEDAR TRCE
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City | PEARL
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State | MS
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Zip | 39208-8611
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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 | 1835P0018X
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Taxonomy Name | Pharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
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License Number | E-100331
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License Number State | MS
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