SHANISE WALLACE

KENOSHA, WI
NPI1114552445
Entity TypeIndividual
GenderFemale
Sole Proprietor ?Yes
Primary Taxonomy183500000X Pharmacist
(Licence: WI  17696-40)
Enumeration Date2020-03-06
Last Update Date2020-03-06
Business Address
SHANISE WALLACE
3710 57TH AVE
KENOSHA, WI 53144-4820
Phone number: 262-652-1474
Mailing Address
SHANISE WALLACE
3710 57TH AVE
KENOSHA, WI 53144-4820
Phone number:
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