DR. JACOB TYLER WALLACE (NPI# 1427338169) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1427338169 |
| Entity Type | Individual |
| Full Name | DR. JACOB TYLER WALLACE |
| Credential | PHARMD |
| Practice Address |
1818 W Dixon Blvd Shelby NC 28152-4351 |
| Practice Telephone | 7044825401 |
| Practice Fax Number | 7044875199 |
| Mailing Telephone | 7044825401 |
| Mailing Fax Number | 7044875199 |
| Enumeration Date | 2011-08-25 |
| Last Update Date | 2017-01-13 |
| Gender Code | M |
| Is Sole Proprietor | Y |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 183500000X | Pharmacist | 21863 | NC | Pharmacy Service Providers |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1275163263 | Jacob Richard Wallace | Nurse Anesthetist, Certified Registered | 200 1st St Sw, Rochester, MN 55905-0001 | 2020-01-19 |
| 1871974527 | Jacob Wallace | Internal Medicine | 1010 N Kansas St, Wichita, KS 67214-3124 | 2015-06-17 |
| 1386809697 | Jacob Wallace II | Counselor | 4368 Lincoln Ave, Oakland, CA 94602-2529 | 2008-07-25 |
| Street Address |
1818 W DIXON BLVD |
| City | SHELBY |
| State | NC |
| Zip Code | 28152-4351 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1265769277 | Robert S Gustashaw | Pharmacist | 1818 W Dixon Blvd, Shelby, NC 28152-4351 | 2009-11-11 |
| 1871928325 | Ingles Markets Inc | Pharmacy | 1818 W Dixon Blvd, Shelby, NC 28152-4351 | 2013-09-03 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1831720820 | The Kid Guru, LLC | Community/Behavioral Health | 6852 Landor Drive, Shelby, NC 28152 | 2020-01-29 |
| 1609370568 | Crossroads Treatment Center of Cleveland County, PC | Community/Behavioral Health | 1895 E Dixon Blvd, Shelby, NC 28152 | 2018-03-23 |
| 1184166944 | Collette Scruggs | Counselor | 200-2 South Post Road, Shelby, NC 28152 | 2016-11-10 |
| 1902277981 | Angela Hamilton Jones | Social Worker | 1243 East Dixon Blvd., Suite 4, Shelby, NC 28152 | 2015-10-15 |
| 1982002614 | Gillian Aloisia Squillacioti | Counselor | 1635 S Dekalb St, Apt 109, Shelby, NC 28152 | 2014-12-11 |
| 1578963765 | Lucy Mcdaniel | Nurse Practitioner | 200 South Post Road, Shelby, NC 28152 | 2014-08-26 |
| 1689086332 | Stanley Todd Bilin | Marriage & Family Therapist | 1243-4 East Dixon Blvd, Shelby, NC 28152 | 2014-05-29 |
| 1144512872 | Sydney M Phipps | Counselor | 1201 S Post Rd # 100, Shelby, NC 28152 | 2011-05-13 |
| 1659602928 | Katherine Ruthsatz Kjergaard | Physician Assistant | 105 East College Street, Shelby, NC 28152 | 2010-01-26 |
| 1407099229 | Cnc / Access, Inc. | Community/Behavioral Health | 1165 Country Home Road, Shelby, NC 28152 | 2009-04-09 |
| Find all providers in zip 28152 | ||||
| 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 |
|---|---|---|---|---|
| 1285184200 | Kyle Ann Kelsey Spinner | Pharmacist | 1950 W Roosevelt Hwy, Shelby, MT 59474-1549 | 2016-10-13 |
| 1992114862 | Mark Brooks | Pharmacist | 701 E Grover St, Shelby, NC 28150-4035 | 2014-08-05 |
| 1205243276 | Jennifer Smoak | Pharmacist | 705 East Dixon Blvd, Shelby, NC 28150 | 2014-07-22 |
| 1487901724 | John Tanner Ringley | Pharmacist | 201 East Grover St., Levine Cancer Institute, Shelby, NC 28150 | 2012-08-06 |
| 1336447085 | Robert Hall | Pharmacist | 1170 E Marion St, Shelby, NC 28150-4845 | 2011-03-04 |
| 1659682433 | Jeffrey A Nunnery | Pharmacist | 706 E Dixon Blvd, Shelby, NC 28152-6832 | 2010-06-28 |
| 1265769277 | Robert S Gustashaw | Pharmacist | 1818 W Dixon Blvd, Shelby, NC 28152-4351 | 2009-11-11 |
| 1336371830 | Kristin Ashley Garling | Pharmacist | 330 W Dixon Blvd, Shelby, NC 28152-6551 | 2009-08-17 |
| 1376777292 | Gloria Franklin | Pharmacist | 204 Vernon Rd, Shelby, OH 44875-1423 | 2009-05-06 |
| 1962683862 | Cynthia Fisher | Pharmacist | 1014 Industry Dr, Suite 2, Shelby, NC 28152-8550 | 2007-11-19 |
| Find all providers in SHELBY | ||||
Please comment or provide details below to improve the information on DR. JACOB TYLER WALLACE.
| 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.