MEDICARE: ALEX J WALLACE R.PH,

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
1	183500000X	Pharmacist		IL

General Provider Information

NPI Number	:	1841290855
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ALEX J WALLACE R.PH,

Provider Business Mailing Address
First Line	:	530 SPRUCE LANE
Second Line	:
City	:	LISLE
State	:	IL
Zip	:	60532-4370
Country	:	US
Telephone Number	:	630-663-1620
Fax Number	:

Provider Business Practice Location Address
First Line	:	530 SPRUCE LANE
Second Line	:
City	:	LISLE
State	:	IL
Zip	:	60532-4370
Country	:	US
Telephone Number	:	630-663-1620
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/01/2005
Last Update Date	:	07/08/2007

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Directions to “ ALEX J WALLACE R.PH,” Practice Location

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