| NPI | 1710038716 |
|---|---|
| Doing Business As | WALLACE DRUG |
| Entity Type | Organization |
| Authorized Contact | DWIGHT WALLACE CEO/PIC 208-397-4540 |
| Organization Subpart ? | No |
| Primary Taxonomy | 3336C0003X Pharmacy, Community/Retail Pharmacy (Licence: ID 1129RP) |
| Additional Taxonomies | 333600000X Pharmacy |
| Enumeration Date | 2007-01-16 |
| Last Update Date | 2017-03-10 |