Cory Wallace, PHARMD

Pharmacist · Broken Arrow, OK

Individual Active NPI

NPI number 1972103745

Practice location

2301 W Kenosha St
Broken Arrow, OK 74012-8912
Phone
(918) 259-9136

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NPI record

NPI
1972103745
Entity type
Individual (Type 1)
Enumeration date
October 29, 2020
Last updated
October 29, 2020
Certified
October 29, 2020
Sole proprietor
Yes

Specialties & taxonomy codes

TaxonomyCodeLicenseState
Pharmacist Primary 183500000X 14955 OK

Mailing address

11005 S Joplin Pl
Tulsa, OK 74137-5023

About Dr. Wallace

Cory Wallace, PHARMD is a healthcare provider registered in the NPI registry with the primary taxonomy Pharmacist (code 183500000X). The practice location is 2301 W Kenosha St, Broken Arrow, OK 74012-8912. The NPI number 1972103745 was assigned on October 29, 2020 and the record was last updated on October 29, 2020.

Dr. Wallace lists a license in the registry: #14955 (OK) for Pharmacist. License numbers are self-reported to NPPES; verify them with the state licensing board.

Frequently asked questions

What is the NPI number of Cory Wallace, PHARMD?

The NPI number is 1972103745.

What is the phone number of Dr. Wallace?

The phone number listed for the practice location is (918) 259-9136.

Where is Dr. Wallace located?

2301 W Kenosha St, Broken Arrow, OK 74012-8912.

What is the taxonomy code for Dr. Wallace?

The primary taxonomy code is 183500000X – Pharmacist.

Is this information correct?

All details come from the public NPPES registry. Providers can update their record at nppes.cms.hhs.gov; changes appear here after the next weekly update.

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