Provider Demographics
NPI:1629076385
Name:BULLARD, WALLENE Z (PHARMD, BCPS)
Entity Type:Individual
Prefix:DR
First Name:WALLENE
Middle Name:Z
Last Name:BULLARD
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:PO BOX 953
Mailing Address - Street 2:
Mailing Address - City:RANDALLSTOWN
Mailing Address - State:MD
Mailing Address - Zip Code:21133-0953
Mailing Address - Country:US
Mailing Address - Phone:202-427-3010
Mailing Address - Fax:202-563-3909
Practice Address - Street 1:750 1ST ST NE
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20002-4241
Practice Address - Country:US
Practice Address - Phone:202-427-3010
Practice Address - Fax:202-563-3909
Is Sole Proprietor?:No
Enumeration Date:2005-07-07
Last Update Date:2010-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD160651835P1200X
NV125741835P1200X
CA476451835P1200X
DCPH1000001751835P1200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P1200XPharmacy Service ProvidersPharmacistPharmacotherapy