Provider Demographics
NPI:1376529321
Name:WALLACE, EMILY CARA (PHARMD)
Entity Type:Individual
Prefix:MS
First Name:EMILY
Middle Name:CARA
Last Name:WALLACE
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:MS
Other - First Name:EMILY
Other - Middle Name:CARA
Other - Last Name:SMITH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PHARMD
Mailing Address - Street 1:1205 N SUNSET DR
Mailing Address - Street 2:
Mailing Address - City:TACOMA
Mailing Address - State:WA
Mailing Address - Zip Code:98406-1028
Mailing Address - Country:US
Mailing Address - Phone:253-752-2532
Mailing Address - Fax:
Practice Address - Street 1:34515 9TH AVE S
Practice Address - Street 2:
Practice Address - City:FEDERAL WAY
Practice Address - State:WA
Practice Address - Zip Code:98003-6761
Practice Address - Country:US
Practice Address - Phone:253-944-7966
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-12-21
Last Update Date:2009-12-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPH00056440183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist