DUANE WALLACE (NPI# 1679730378) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1679730378 |
| Entity Type | Individual |
| Full Name | DUANE WALLACE |
| Credential | RPH |
| Practice Address |
665 3rd St Sw Perham MN 56573-1137 |
| Practice Telephone | 2183461169 |
| Practice Fax Number | 2183461279 |
| Mailing Telephone | 2183461169 |
| Mailing Fax Number | 2183461279 |
| Enumeration Date | 2008-05-20 |
| Last Update Date | 2008-05-20 |
| Gender Code | M |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 183500000X | Pharmacist | 114023 | MN | Pharmacy Service Providers |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1932443132 | Duane Isabel Wallace | Counselor | 151 Bent Ridge Dr S, Dawsonville, GA 30534-3337 | 2012-11-12 |
| 1932434974 | Duane Anthony Wallace | Counselor | 1 W Geneva St, Credence Therapy Associates, Elkhorn, WI 53121-1722 | 2009-10-08 |
| 1437328713 | Duane Leo Wallace | Dentist | 63 Geiger Road, Rome, NY 13441 | 2008-02-21 |
| Street Address |
665 3RD ST SW |
| City | PERHAM |
| State | MN |
| Zip Code | 56573-1137 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1194793562 | Richard W Masur | Emergency Medicine | 665 3rd St Sw, Perham, MN 56573-1108 | 2006-03-10 |
| 1508146846 | Sanford Medical Center Fargo | Family Medicine | 665 3rd St Sw, Perham, MN 56573-1137 | 2011-08-18 |
| 1457631814 | Perham Hospital District | Internal Medicine | 665 3rd St Sw, Perham, MN 56573-1199 | 2011-08-17 |
| 1760786032 | Marisa Lea Zutter | Nurse Practitioner | 665 3rd St Sw, Perham, MN 56573-1137 | 2010-12-30 |
| 1528220498 | Amy Marie Vogt | Pharmacist | 665 3rd St Sw, Suite 100, Perham, MN 56573-1137 | 2008-07-01 |
| 1770760605 | Ronica Marie Wahl | Nurse Practitioner | 665 3rd St Sw, Perham, MN 56573-1137 | 2008-01-22 |
| 1710905351 | Stephen R Hietala | Family Medicine | 665 3rd St Sw, Perham, MN 56573-1108 | 2006-07-18 |
| 1225056955 | Jeffrey L Blickenstaff | Family Medicine | 665 3rd St Sw, Perham, MN 56573-1108 | 2006-07-18 |
| 1386661858 | Corey L Nyhus | Family Medicine | 665 3rd St Sw, Perham, MN 56573-1108 | 2006-07-17 |
| 1295766392 | Mark R Paulson | Family Medicine | 665 3rd St Sw, Perham, MN 56573-1108 | 2006-07-06 |
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| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1558630012 | Perham Hospital District | Durable Medical Equipment & Medical Supplies | 1000 Coney Street West, Perham, MN 56573 | 2011-12-29 |
| 1730239385 | Dr. Kelvin K. Salathe, P.C. | Chiropractor | 101 West Coney St, Perham, MN 56573 | 2007-01-12 |
| 1124106299 | Langen Family Chiropractic, P.a. | Chiropractor | 108 Market Dr., Perham, MN 56573 | 2006-11-02 |
| 1285710335 | James Odin Langen | Chiropractor | 108 Market Drive, Perham, MN 56573 | 2006-10-31 |
| 1578572202 | Michael L Hamann | Dentist | 200 1st Ave S, Perham, MN 56573 | 2006-08-05 |
| 1033133517 | Timothy Charles Neitzke | Optometrist | 340 Fox St, Perham, MN 56573 | 2006-07-27 |
| 1023063757 | Shopko Stores Operating Co LLC | Pharmacy | 300 Jake St, Perham, MN 56573 | 2006-05-23 |
| 1164917233 | Katlin Larson | Behavior Technician | 735 3rd St Sw, Perham, MN 56573 | 2018-06-29 |
| 1104029347 | Tammy L Sturdevant | Dentist | 335 4th Ave, Perham, MN 56573 | 2007-06-06 |
| 1861610131 | Minnesota Eyecare Network Inc. | Eyewear Supplier (Equipment, not the service) | 340 Fox Street, Perham, MN 56573 | 2007-04-23 |
| Find all providers in zip 56573 | ||||
| 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 |
|---|---|---|---|---|
| 1003234246 | Wanda Drewes | Pharmacist | 300 Jake Str Se, Perham, MN 56544 | 2014-04-04 |
| 1669813796 | Wilma Ann Certain | Pharmacist | 125 1st Ave S, Perham, MN 56573-1701 | 2013-07-17 |
| 1174001648 | Jodie Trites | Pharmacist | 1000 Coney St W, Perham, MN 56573-2102 | 2018-08-06 |
| 1699181388 | Haylee Preabt | Pharmacist | 125 1st Ave S, Perham, MN 56573-1701 | 2014-07-02 |
| 1942642806 | James Witt | Pharmacist | 125 1st Ave S, Perham, MN 56573-1701 | 2013-07-20 |
| 1528220498 | Amy Marie Vogt | Pharmacist | 665 3rd St Sw, Suite 100, Perham, MN 56573-1137 | 2008-07-01 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1588265649 | Candace Louise Haugtvedt | Pharmacist | 321 Us-10 West, Detroit Lakes, MN 56501 | 2020-11-05 |
| 1295334217 | Mary Jane Andersen | Pharmacist | 3300 Hwy 210 W, Fergus Falls, MN 56537 | 2020-10-21 |
| 1679172522 | Cari Michelle Labonne | Pharmacist | 4202 Creekwood Pl, Hermantown, MN 55811-3692 | 2020-10-21 |
| 1073112983 | Katie Sue Fairchild | Pharmacist | 2301 E Frontage Rd, Litchfield, MN 55355 | 2020-10-21 |
| 1609475615 | Blaine Perry Ecker | Pharmacist | 3300 Highway 210 W., 3300 Highway 210 West, Fergus Falls, MN 56537 | 2020-10-21 |
| 1619576626 | Jessica Margaret Dulli | Pharmacist | 5241 Lincoln Dr Apt 204, Edina, MN 55436-2702 | 2020-10-21 |
| 1649879875 | Dale Rudolph | Pharmacist | 320 22nd Ave Ne, Waseca, MN 56093-2670 | 2020-10-19 |
| 1134728520 | Herve Bertrand Kengne Mbakam | Pharmacist | 1800 Windsor Dr S, Shakopee, MN 55379-8073 | 2020-10-18 |
| 1821696402 | Leah Fischer | Pharmacist | 817 11th St N, New Ulm, MN 56073-1374 | 2020-10-15 |
| 1003414780 | Loren Leroy Carver | Pharmacist | 424 3rd St N, Stillwater, MN 55082-4836 | 2020-10-14 |
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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.