DR. Larique Wallace, PHARMD

NPI #1114592714 in Stamford, Connecticut

Provider Information

NPI Number: 1114592714
Entity Type: Individual
Name: DR. Larique Wallace, PHARMD
Gender: Not Specified
Sole Proprietor: Yes
Primary Specialty: Pharmacist
Credential: PHARMD
Enumeration Date: May 25, 2021
Last Updated: May 26, 2021

Practice Location

Address: 780 E MAIN ST
City: Stamford
State: Connecticut
ZIP Code: 06902-3832
Phone: (203) 353-9117

Specialties & Taxonomy Codes

Specialty	Taxonomy Code	Primary
Pharmacist	183500000X	Primary

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