Provider Demographics
NPI:1124564265
Name:PLYLER, WALLACE H JR
Entity Type:Individual
Prefix:MR
First Name:WALLACE
Middle Name:H
Last Name:PLYLER
Suffix:JR
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:150 CONCORD COMMONS PL SW
Mailing Address - Street 2:
Mailing Address - City:CONCORD
Mailing Address - State:NC
Mailing Address - Zip Code:28027-5026
Mailing Address - Country:US
Mailing Address - Phone:704-788-3138
Mailing Address - Fax:704-788-3150
Practice Address - Street 1:150 CONCORD COMMONS PL SW
Practice Address - Street 2:
Practice Address - City:CONCORD
Practice Address - State:NC
Practice Address - Zip Code:28027-5026
Practice Address - Country:US
Practice Address - Phone:704-788-3138
Practice Address - Fax:704-788-3150
Is Sole Proprietor?:No
Enumeration Date:2017-01-12
Last Update Date:2017-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC12673183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist