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Kole Wallace
NPI 1760039192 · on the registry since 2019
Practice
- Address
- 1009 Park Ave W
Mansfield, OH 44906 - Phone
- (419) 525-7300
- Organisation at this address
- Rite Aid Of Ohio Inc
Inferred from a shared address, not stated in the registry.
- Clinicians at this address
- 3
Registry record
- Primary taxonomy
- 183500000X
183500000X
- Licence states on file
- OH
From the registry's licence fields, which are often incomplete.
- Sex
- Male
- Record last updated
- 2019-08-21
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 Ohio