| Doctor Name: | DR. MICAH JORDAN WALLACE |
| NPI Number: | 1003241571 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | PHARM.D. |
| License Number: | 36630 |
| Business Practice Address: | 2152 Savannah Hwy Charleston, SC - 294145311 |
| Business Phone Number: | 8435568974 |
| Business Fax Number: | |
| Mailing Address: | 2152 Savannah Hwy, CHARLESTON |
| State: | SC |
| Postal Code: | 294145311 |
| Phone Number: | 8435568974 |
| Fax Number: | |
| NPI Enumeration Date: | 09/03/2013 |
| NPI Last Update Date: | 09/03/2013 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 183500000X |
| License Number: | 36630 |
| Healthcare Provider Taxonomy: (Secondary) | N |
| State: | TN |
| Taxonomy Type: | Pharmacy Service Providers |
| Taxonomy Classification: | Pharmacist |
| Taxonomy Specialization: | |
| Taxonomy Definition: | An individual licensed by the appropriate state regulatory agency to engage in the practice of pharmacy. The practice of pharmacy includes, but is not limited to, assessment, interpretation, evaluation, and implementation, initiation, monitoring or modification of medication and or medical orders; the compounding or dispensing of medication and or medical orders; participation in drug and device procurement, storage, and selection; drug administration; drug regimen reviews; drug or drug-related research; provision of patient education and the provision of those acts or services necessary to provide medication therapy management services in all areas of patient care. |