Provider Demographics
NPI:1851720759
Name:WALL, LINDSAY (PHARMACIST)
Entity Type:Individual
Prefix:DR
First Name:LINDSAY
Middle Name:
Last Name:WALL
Suffix:
Gender:F
Credentials:PHARMACIST
Other - Prefix:DR
Other - First Name:LINDSAY
Other - Middle Name:
Other - Last Name:WALL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:4610 N CLARK ST # 1041
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60640-4620
Mailing Address - Country:US
Mailing Address - Phone:132-196-0641
Mailing Address - Fax:
Practice Address - Street 1:417 E 90TH ST
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10128-5147
Practice Address - Country:US
Practice Address - Phone:888-638-1180
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-11-01
Last Update Date:2024-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL0513052431835P0018X, 1835P1200X, 183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
No1835P0018XPharmacy Service ProvidersPharmacistPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
No1835P1200XPharmacy Service ProvidersPharmacistPharmacotherapy