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NPI Code Detail

MEDICARE: DAVID MICHAEL WALLACE PHARMD

MEDICARE: DAVID MICHAEL WALLACE PHARMD
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
1183500000XPharmacist34080NC

General Provider Information

NPI Number : 1720943053
Entity Type Code : Individual
Provider Name (Legal Business Name) : DAVID MICHAEL WALLACE PHARMD
Provider Business Mailing Address
First Line : 1706 N SANDHILLS BLVD
Second Line :
City : ABERDEEN
State : NC
Zip : 28315-2338
Country : US
Telephone Number : 910-944-1502
Fax Number :
Provider Business Practice Location Address
First Line : 1706 N SANDHILLS BLVD
Second Line :
City : ABERDEEN
State : NC
Zip : 28315-2338
Country : US
Telephone Number : 910-944-1502
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 12/18/2025
Last Update Date : 12/18/2025

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Directions to “ DAVID MICHAEL WALLACE PHARMD” Practice Location

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