MEDICARE: DR. STARLA 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
1	183500000X	Pharmacist	S026453	AZ

General Provider Information

NPI Number	:	1922882281
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. STARLA WALLACE PHARMD

Provider Business Mailing Address
First Line	:	25401 N LAKE PLEASANT PKWY
Second Line	:
City	:	PEORIA
State	:	AZ
Zip	:	85383-1351
Country	:	US
Telephone Number	:	623-235-2360
Fax Number	:	623-235-2361

Provider Business Practice Location Address
First Line	:	25401 N LAKE PLEASANT PKWY
Second Line	:
City	:	PEORIA
State	:	AZ
Zip	:	85383-1351
Country	:	US
Telephone Number	:	623-235-2360
Fax Number	:	623-235-2361

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

Provider Enumeration Date	:	08/18/2023
Last Update Date	:	06/12/2026

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