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NPI Code Detail

MEDICARE: DR. HEATHER FREEMAN WALLACE

MEDICARE:  DR. HEATHER FREEMAN WALLACE
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1183500000XPharmacist21831NC

General Provider Information

NPI Number : 1316227051
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. HEATHER FREEMAN WALLACE
Provider Business Mailing Address
First Line : 232 CARPENTER RD
Second Line :
City : BESSEMER CITY
State : NC
Zip : 28016-9711
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 715 W TRADE ST
Second Line :
City : DALLAS
State : NC
Zip : 28034-1544
Country : US
Telephone Number : 704-922-7187
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/25/2011
Last Update Date : 01/13/2017

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Directions to “ DR. HEATHER FREEMAN WALLACE ” Practice Location

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