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NPI Code Detail

MEDICARE: MR. WALLACE JOSEPH OLINDE RPH

MEDICARE: MR. WALLACE JOSEPH OLINDE 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
1183500000XPharmacist13347LA
2183500000XPharmacist26762TX

General Provider Information

NPI Number : 1871504886
Entity Type Code : Individual
Provider Name (Legal Business Name) : MR. WALLACE JOSEPH OLINDE RPH
Provider Business Mailing Address
First Line : 101 TYREE DR
Second Line :
City : WEST MONROE
State : LA
Zip : 71291-7542
Country : US
Telephone Number : 318-237-9222
Fax Number : 318-343-8600
Provider Business Practice Location Address
First Line : 250 DESIARD PLAZA DR
Second Line :
City : MONROE
State : LA
Zip : 71203-4955
Country : US
Telephone Number : 318-345-5599
Fax Number : 318-343-8600
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/11/2006
Last Update Date : 07/08/2007

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