Dwight D Wallace, PHARMD is a
Pharmacist based in Aberdeen, Idaho. Dwight D Wallace is licensed to practice in Idaho (license number P4895) and his current practice location is
44 S. Main St, Aberdeen, Idaho. He can be reached at his office (for appointments etc.) via phone at
(208) 397-4540.
NPI number for Dwight D Wallace is 1104245620 and his current mailing address is Po Box 841, Aberdeen, Idaho. He
does not participate in medicare program and thus does not accept medicare assignments. His NPI Number is 1104245620.
Healthcare Provider's Profile
| Full Name | Dwight D Wallace |
|---|
| Gender | Male |
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| Speciality | Pharmacist |
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| Location | 44 S. Main St, Aberdeen, Idaho |
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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: 1104245620
- Provider Enumeration Date: 04/11/2014
- Last Update Date: 04/11/2014
Medical Identifiers
Medical identifiers for Dwight D Wallace such as npi, medicare ID, medicare PIN, medicaid, etc.
| Identifier | Type | State | Issuer |
|---|
| 1104245620 | NPI | - | NPPES |
Medical Taxonomies and Licenses
| Taxonomy | Type | License (State) | Status |
|---|
| 183500000X | Pharmacist | P4895 (Idaho) | 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. Dwight D 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 |
|---|
Dwight D Wallace, PHARMD
Po Box 841,
Aberdeen, ID 83210-0841
Ph: (208) 397-4540 | Dwight D Wallace, PHARMD
44 S. Main St,
Aberdeen, ID 83210
Ph: (208) 397-4540 |
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