Wallace, Kristie Jackson

Wallace, Kristie Jackson is an individual health care provider with primary practice located at 499 Laguna Dr , St Petersburg FL 33715-1842. She recently has only one registered license in Pharmacy Service Providers / Pharmacotherapy, which is considered as her primary health care specialty. Wallace, Kristie Jackson can be contacted via phone (727) 542-1340.

Contact Information

Primary practice address
499 Laguna Dr St Petersburg FL 33715-1842
Phone: (727) 542-1340
Fax: (727) 865-6040
Website:
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Health care specialties

SpecialtyCodeLicense #State
Pharmacy Service Providers / Pharmacotherapy 1835P1200X PS27159 Florida

Profile Details

NPI number 1154324861
LBN Legal business name Wallace, Kristie Jackson
Credentials PHARMD
Entity Individual
Sole proprietor 1 No
Enumeration date May 27th, 2005
Last updated Jul 8th, 2007 - about 17 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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