Provider Demographics
NPI:1801199229
Name:WALLACE, KARYN E (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:KARYN
Middle Name:E
Last Name:WALLACE
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PSC 490 BOX 7667
Mailing Address - Street 2:
Mailing Address - City:FPO
Mailing Address - State:AP
Mailing Address - Zip Code:96538-0490
Mailing Address - Country:US
Mailing Address - Phone:671-344-9624
Mailing Address - Fax:
Practice Address - Street 1:PSC 490 BOX 7667
Practice Address - Street 2:
Practice Address - City:FPO
Practice Address - State:AP
Practice Address - Zip Code:96538-0490
Practice Address - Country:US
Practice Address - Phone:671-344-9624
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-12-07
Last Update Date:2010-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC13020183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist