Kennis Hal Wallace JR., RPH

NPI #1811981939 in Harrisburg, Illinois

Provider Information

NPI Number: 1811981939
Entity Type: Individual
Name: Kennis Hal Wallace JR., RPH
Gender: Not Specified
Sole Proprietor: Not Answered
Primary Specialty: Pharmacist
Credential: RPH
Enumeration Date: Sep 2, 2005
Last Updated: Jul 8, 2007

Practice Location

Address: 303 S COMMERCIAL ST
Address 2: PARKER PLAZA
City: Harrisburg
State: Illinois
ZIP Code: 62946-2125
Phone: (618) 253-7621

Specialties & Taxonomy Codes

Specialty	Taxonomy Code	Primary
Pharmacist	183500000X	Primary

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