Provider Demographics
NPI:1871504886
Name:OLINDE, WALLACE JOSEPH (RPH)
Entity Type:Individual
Prefix:MR
First Name:WALLACE
Middle Name:JOSEPH
Last Name:OLINDE
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:101 TYREE DR
Mailing Address - Street 2:
Mailing Address - City:WEST MONROE
Mailing Address - State:LA
Mailing Address - Zip Code:71291-7542
Mailing Address - Country:US
Mailing Address - Phone:318-237-9222
Mailing Address - Fax:318-343-8600
Practice Address - Street 1:250 DESIARD PLAZA DR
Practice Address - Street 2:
Practice Address - City:MONROE
Practice Address - State:LA
Practice Address - Zip Code:71203-4955
Practice Address - Country:US
Practice Address - Phone:318-345-5599
Practice Address - Fax:318-343-8600
Is Sole Proprietor?:No
Enumeration Date:2006-08-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA13347183500000X
TX26762183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist