Brianna Marie Wallace, PharmD
Pharmacist, Pharmacist Clinician (PhC)/ Clinical Pharmacy Specialist in Evergreen Park, IL. Individual provider (NPI-1).
NPI number1649986555
StatusActive
Last updated in NPPESJan 24, 2023
Details
- NPI
- 1649986555
- Entity type
- Individual (NPI-1)
- Name
- Brianna Marie Wallace
- Credential
- PharmD
- Sex
- Female
- Sole proprietor
- No
- Enumeration date
- Jan 24, 2023
- Certification date
- Jan 24, 2023
- Last updated
- Jan 24, 2023
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 1835P0018X | Pharmacist, Pharmacist Clinician (PhC)/ Clinical Pharmacy Specialist | 051.304975 | IL | Yes |
Practice location
8700 S Kedzie AveEvergreen Park, IL 60805-1024
Phone 708-499-8051
Mailing address
12349 S Meade AvePalos Heights, IL 60463-1834
Phone 708-843-1861
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