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NPI Code Detail

MEDICARE: MARQUITA WALLACE PHARMD, RPH

MEDICARE: MARQUITA WALLACE PHARMD, RPH
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
1183500000XPharmacistPS15358FL

General Provider Information

NPI Number : 1609268911
Entity Type Code : Individual
Provider Name (Legal Business Name) : MARQUITA WALLACE PHARMD, RPH
Provider Business Mailing Address
First Line : 6006 BEACH BLVD
Second Line :
City : JACKSONVILLE
State : FL
Zip : 32216-2702
Country : US
Telephone Number : 904-727-6006
Fax Number :
Provider Business Practice Location Address
First Line : 6006 BEACH BLVD
Second Line :
City : JACKSONVILLE
State : FL
Zip : 32216-2702
Country : US
Telephone Number : 904-727-6006
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/24/2015
Last Update Date : 02/24/2015

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Directions to “ MARQUITA WALLACE PHARMD, RPH” Practice Location

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