MR. MARK JAMES WALLACE (NPI# 1205110434) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1205110434 |
| Entity Type | Individual |
| Full Name | MR. MARK JAMES WALLACE |
| Credential | DOCTOR OF PHARMACY |
| Practice Address |
301 S Sante Fe Ave Edmond OK 73003 |
| Practice Telephone | 4053306093 |
| Practice Fax Number | 4053306153 |
| Mailing Telephone | 4053306093 |
| Mailing Fax Number | 4053306153 |
| Enumeration Date | 2011-10-06 |
| Last Update Date | 2011-10-06 |
| Gender Code | M |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 183500000X | Pharmacist | 11913 | OK | Pharmacy Service Providers |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1538533005 | Mark Thomas Wallace | Speech-Language Pathologist | 2337 N 2nd St, Harrisburg, PA 17110-1009 | 2015-11-21 |
| 1942241096 | Mark Alan Wallace | Chiropractor | 2140 W Poplar Ave, Suite 107, Collierville, TN 38017-0624 | 2006-06-09 |
| 1669467213 | Mark Spangler Wallace | Dentist | 168 N 1950 W Ste 202, Salt Lake City, UT 84116-3007 | 2005-09-20 |
| 1932104205 | Mark Randall Wallace | Internal Medicine | 13400 E Shea Blvd, Scottsdale, AZ 85259 | 2005-06-14 |
| 1760753008 | Mark Edward Wallace | Psychiatry & Neurology | 77 7th Ave, #19d, New York, NY 10011-6645 | 2012-01-18 |
| 1932367539 | Mark Richard Wallace | Chiropractor | 9337 W 75th St, Overland Park, KS 66204 | 2008-05-30 |
| 1316119548 | Mark Steven Wallace | Hearing Instrument Specialist | 202 Grand Ave, Spencer, IA 51301 | 2008-03-27 |
| 1952591828 | Mark Allen Wallace | Otolaryngology | 333 Magazine St, Suite 101, Sault Sainte Marie, MI 49783-1867 | 2007-07-27 |
| 1104047190 | Mark C Wallace | Dentist | 50 County Road B E, Saint Paul, MN 55117-1927 | 2007-05-01 |
| 1548358047 | Mark Arthur Wallace | Dentist | 1901 Research Blvd, Suite 200, Rockville, MD 20850-3164 | 2006-10-10 |
| Street Address |
301 S SANTE FE AVE |
| City | EDMOND |
| State | OK |
| Zip Code | 73003 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1851675144 | Sarah Ann Wssmann | Pharmacist | 301 S Sante Fe Ave, Edmond, OK 73003 | 2011-10-05 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1154945202 | Korbin Hally | Dentist | 2600 Tayler Street, Edmond, OK 73003 | 2020-06-04 |
| 1003448325 | Diagnostic Resources, LLC | Physical Medicine & Rehabilitation | 1641 Saratoga Way, Edmond, OK 73003 | 2020-02-05 |
| 1861904021 | Rhonda Diane Pennington | Occupational Therapist | 515 S Santa Fe Ave Ste 103, Edmond, OK 73003 | 2017-10-27 |
| 1588173744 | Hpc Holdings LLC | Clinic/Center | 813 W Covell Rd, Edmond, OK 73003 | 2017-09-20 |
| 1194243568 | Nightengale Chiropractic, LLC | Chiropractor | 2616 Covell Village Dr Ste. 120, Edmond, OK 73003 | 2017-09-06 |
| 1104274927 | Bonsu Osei Asibey | Case Manager/Care Coordinator | 1301 Craig Blvd, Edmond, OK 73003 | 2016-06-02 |
| 1215390810 | Prince Yebo | Case Manager/Care Coordinator | 1817 Redland Dr, Edmond, OK 73003 | 2016-03-31 |
| 1548621691 | Charles Loftis | Physical Therapist | 1321 Fretz Drive, 100, Edmond, OK 73003 | 2016-03-17 |
| 1487013801 | Courage Counseling Center | Community/Behavioral Health | 1400 S. Fretz Ave, Suite 1400, Edmond, OK 73003 | 2016-02-12 |
| 1669889887 | Shannon Gogel | Occupational Therapy Assistant | 1309 Val Genes Rd, Edmond, OK 73003 | 2014-07-21 |
| Find all providers in zip 73003 | ||||
| Taxonomy Code | 183500000X |
| Grouping | Pharmacy Service Providers |
| Classification | Pharmacist |
| 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. |
| Notes: Source: Adapted from National Association of Boards of Pharmacy Model State Pharmacy Act, Article 1, Section 104. [1/1/2006: definition modified, source modified] |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1972104099 | James R Hargis | Pharmacist | 1820 Rosedale Dr, Edmond, OK 73013-6638 | 2020-11-04 |
| 1194339861 | Susan Haesook Kim | Pharmacist | 1400 2nd St, Edmod, Edmond, OK 73034 | 2020-09-01 |
| 1578175246 | Stefan Joseph Miranov | Pharmacist | 1308 N Bryant Ave, Edmond, OK 73034-4950 | 2020-08-23 |
| 1851858492 | Luma Hilal | Pharmacist | 2228 Nw 15th Terrace, Edmond, OK 73013 | 2019-03-01 |
| 1033685730 | Chad Alan Caldwell | Pharmacist | 4833 Integris Pkwy Ste 130, Edmond, OK 73034-8864 | 2018-10-19 |
| 1881171528 | David L George | Pharmacist | 14101 N Eastern Ave Ste A, Edmond, OK 73013-5860 | 2018-07-25 |
| 1295270494 | Barbara Fang | Pharmacist | 3051 Willowood Rd, Edmond, OK 73034-9725 | 2016-12-23 |
| 1144625138 | Renae M Kraft | Pharmacist | 1101 Nw 178th St Ste A, Edmond, OK 73012-4281 | 2014-11-03 |
| 1255778452 | Shannan Denise Wideman | Pharmacist | 701 Fox Run Trl, Edmond, OK 73034-7360 | 2013-05-29 |
| 1922354208 | Kristen Winters | Pharmacist | 1701 Renaissance Blvd Ste 120, Edmond, OK 73013-3086 | 2012-07-24 |
| Find all providers in EDMOND | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.