Dr Tyson Wallace, PHARM D is a
Pharmacist based in Gosnell, Arkansas. Dr Tyson Wallace is licensed to practice in Arkansas (license number PD09924) and his current practice location is
134 Bevill Ave, Gosnell, Arkansas. He can be reached at his office (for appointments etc.) via phone at
(870) 751-9242.
NPI number for Dr Tyson Wallace is 1982296877 and his current mailing address is 134 Bevill Ave, Gosnell, Arkansas. He
does not participate in medicare program and thus does not accept medicare assignments. His NPI Number is 1982296877.
Healthcare Provider's Profile
| Full Name | Dr Tyson Wallace |
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| Gender | Male |
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| Speciality | Pharmacist |
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| Location | 134 Bevill Ave, Gosnell, Arkansas |
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| Accepts Medicare Assignments | Does not participate in Medicare Program. He may not accept medicare assignment. |
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NPI Data:
- NPI Number: 1982296877
- Provider Enumeration Date: 02/11/2021
- Last Update Date: 02/11/2021
Medical Identifiers
Medical identifiers for Dr Tyson Wallace such as npi, medicare ID, medicare PIN, medicaid, etc.
| Identifier | Type | State | Issuer |
|---|
| 1982296877 | NPI | - | NPPES |
Medical Taxonomies and Licenses
| Taxonomy | Type | License (State) | Status |
|---|
| 183500000X | Pharmacist | 2007005629 (Missouri) | Secondary |
| 183500000X | Pharmacist | PD09924 (Arkansas) | Primary |
Medicare Part D Prescriber Enrollment
Any physician or other eligible professional who prescribes Part D drugs must either enroll in the Medicare program or opt out in order to prescribe drugs to their patients with Part D prescription drug benefit plans. Dr Tyson Wallace is
NOT enrolled with medicare and thus cannot prescribe medicare part D drugs to patients with medicare part D benefits.
Mailing Address and Practice Location
| Mailing Address | Practice Location Address |
|---|
Dr Tyson Wallace, PHARM D
134 Bevill Ave,
Gosnell, AR 72315
Ph: (870) 751-9242 | Dr Tyson Wallace, PHARM D
134 Bevill Ave,
Gosnell, AR 72315
Ph: (870) 751-9242 |
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