Cory Wallace, PHARMD
NPI #1972103745 in Broken Arrow, Oklahoma
Provider Information
- NPI Number
- 1972103745
- Entity Type
- Individual
- Name
- Cory Wallace, PHARMD
- Gender
- Not Specified
- Sole Proprietor
- Yes
- Primary Specialty
- Pharmacist
- Credential
- PHARMD
- Enumeration Date
- Oct 29, 2020
- Last Updated
- Oct 29, 2020
Practice Location
- Address
- 2301 W KENOSHA ST
- City
- Broken Arrow
- State
- Oklahoma
- ZIP Code
- 74012-8912
- Phone
- (918) 259-9136
Specialties & Taxonomy Codes
| Specialty |
|---|
| Pharmacist |
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