Provider Demographics
NPI:1548004906
Name:WALLACE, CHRISTOPHER OGBOE (PHARMD)
Entity type:Individual
Prefix:
First Name:CHRISTOPHER
Middle Name:OGBOE
Last Name:WALLACE
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7423 KELLY DR
Mailing Address - Street 2:
Mailing Address - City:NORRISTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:19401-6246
Mailing Address - Country:US
Mailing Address - Phone:929-338-8109
Mailing Address - Fax:
Practice Address - Street 1:1040 W CHESTER PIKE
Practice Address - Street 2:
Practice Address - City:WEST CHESTER
Practice Address - State:PA
Practice Address - Zip Code:19382-5003
Practice Address - Country:US
Practice Address - Phone:610-344-7469
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-06-20
Last Update Date:2024-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARP458315183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist