Provider Demographics
NPI:1437287943
Name:WALLIN-WAIS, JO LYNNE (PHARMD, BCPS)
Entity Type:Individual
Prefix:
First Name:JO
Middle Name:LYNNE
Last Name:WALLIN-WAIS
Suffix:
Gender:F
Credentials:PHARMD, BCPS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2308 W ROGERS AVE
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21209-4426
Mailing Address - Country:US
Mailing Address - Phone:410-664-8717
Mailing Address - Fax:443-849-3447
Practice Address - Street 1:5701 N CHARLES ST
Practice Address - Street 2:SUITE 5218
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21210-1315
Practice Address - Country:US
Practice Address - Phone:443-849-3786
Practice Address - Fax:443-849-8447
Is Sole Proprietor?:No
Enumeration Date:2007-02-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD115601835P1200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P1200XPharmacy Service ProvidersPharmacistPharmacotherapy