Data from the NPPES registry. May not reflect recent changes — verify at nppes.cms.hhs.gov.
DWIGHT D. WALLACE, PHARMD
Active Sole ProprietorPharmacist · ABERDEEN, ID
Registration Details
- NPI Number
- 1104245620
- Provider Type
- Individual
- Gender
- Male
- NPI Issued
- Apr 11, 2014 (12.078509550969 yrs)
- Last Updated
- Apr 11, 2014
- License
-
P4895 (ID)
- Sole Proprietor
- Yes
Practice Information
- Address
-
44 S. MAIN STABERDEEN, ID, 83210Browse ID providers · Browse ZIP 83210
- Phone
- 2083974540
- Primary Specialty
-
Pharmacist
183500000X
Data sourced from the NPPES National Provider Identifier registry. This information is for informational purposes only and is not a substitute for verifying credentials with the appropriate licensing authority. For official verification, use the NPPES NPI Registry or the relevant state medical board.