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Keith Wallace, BS PHARM
NPI 1750408795 · on the registry since 2007
Practice
- Address
- 11643 Lilburn Park Rd
Saint Louis, MO 63146 - Phone
- (314) 995-6843
- Fax
- (888) 916-0877
- Organisation at this address
- Missouri Med Llc
Inferred from a shared address, not stated in the registry.
Registry record
- Primary taxonomy
- Pharmacist
183500000X
- Licence states on file
- MO
From the registry's licence fields, which are often incomplete.
- Sex
- Male
- Record last updated
- 2011-01-14
Source: CMS National Plan and Provider Enumeration System. Registration is not the same as practising, and the registry records no retirement — some people listed here no longer practise. More in Missouri