Provider Demographics
NPI:1184990244
Name:LALLIER, WAYNE R (R PH)
Entity type:Individual
Prefix:MR
First Name:WAYNE
Middle Name:R
Last Name:LALLIER
Suffix:
Gender:M
Credentials:R PH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:232 G ST
Mailing Address - Street 2:
Mailing Address - City:SALIDA
Mailing Address - State:CO
Mailing Address - Zip Code:81201-2019
Mailing Address - Country:US
Mailing Address - Phone:719-539-6933
Mailing Address - Fax:719-539-1538
Practice Address - Street 1:232 G ST
Practice Address - Street 2:
Practice Address - City:SALIDA
Practice Address - State:CO
Practice Address - Zip Code:81201-2019
Practice Address - Country:US
Practice Address - Phone:719-539-6933
Practice Address - Fax:719-539-1538
Is Sole Proprietor?:No
Enumeration Date:2012-03-22
Last Update Date:2012-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO8947183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist