Individual provider · Type 1 NPI

Keith Alan Wallace, BS PHARM

Pharmacist · St. Louis, MO

NPI number 1750408795 Active

Practice location

11643 Lilburn Park Rd
St. Louis, MO 63146-3535

Call (314) 995-6843 Map

Fax (888) 916-0877

Mailing address

5 Woodland Ridge Ct
St. Peters, MO 63376-1788

Specialties and licenses

TaxonomyCodeLicense
Pharmacist Primary 183500000X2001019315 (MO)

Pharmacist: An individual licensed by the appropriate state regulatory agency to engage in the practice of pharmacy. The practice of pharmacy includes, but is not limited to, assessment, interpretation, evaluation, and implementation, initiation, monitoring or modification of medication and or medical orders; the compounding or dispensing of medication and or medical orders; participation in drug and device procurement, storage…

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About NPI 1750408795

Keith Alan Wallace, BS PHARM's National Provider Identifier is 1750408795, issued on Mar 23, 2007. The primary taxonomy on file is Pharmacist (183500000X), and the practice location is in St. Louis, MO. The record was last updated on Jan 14, 2011.