NPI 1003161639

Guy Wallace

Practitioner Pharmacist Atlanta, GA

Practice location

Address: 500 Brookhaven Ave NE, Atlanta, GA 30319-3291
Phone: (404) 460-1924
Fax: (404) 460-1921

Registered specialties

Pharmacist Primary

Pharmacy Service Providers Taxonomy 183500000X Licence 018447 (GA)

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Registry record

NPI: 1003161639
Entity type: Individual
Sex (as registered): Male
NPI issued: 19 Jul 2012
Record last updated: 19 Jul 2012

Reproduced from NPPES, the federal provider registry. The date above is when the provider last updated their own entry, not when we fetched it - a record can be years old and still current in the registry.