CORY WALLACE (NPI# 1972103745) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1972103745 |
| Entity Type | Individual |
| Full Name | CORY WALLACE |
| Credential | PHARMD |
| Practice Address |
2301 W Kenosha St Broken Arrow OK 74012-8912 |
| Mailing Address |
11005 S Joplin Pl Tulsa OK 74137-5023 |
| Practice Telephone | 9182599136 |
| Enumeration Date | 2020-10-29 |
| Last Update Date | 2020-10-29 |
| Gender Code | M |
| Is Sole Proprietor | Y |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 183500000X | Pharmacist | 14955 | OK | Pharmacy Service Providers |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1447740238 | Cory Alexis Wallace | Behavior Technician | 5801 Ne Cornelius Pass Rd, Hillsboro, OR 97124-9370 | 2018-05-16 |
| 1780998112 | Cory L Wallace | Podiatrist | 4330 Medical Dr, Ste 500, San Antonio, TX 78229-3342 | 2010-07-27 |
| Street Address |
2301 W KENOSHA ST |
| City | BROKEN ARROW |
| State | OK |
| Zip Code | 74012-8912 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1043237167 | Wal-mart Stores East Lp | Durable Medical Equipment & Medical Supplies | 2301 W Kenosha St, Broken Arrow, OK 74012-8912 | 2006-07-16 |
| 1952902447 | Sandra Souvannachak | Pharmacist | 2301 W Kenosha St, Broken Arrow, OK 74012-8912 | 2020-11-03 |
| 1942820386 | Ashley Mcmahon | Pharmacist | 2301 W Kenosha St, Broken Arrow, OK 74012-8912 | 2020-04-24 |
| 1548309164 | Rediclinic LLC | Clinic/Center | 2301 W Kenosha St, Broken Arrow, OK 74012-8912 | 2007-02-06 |
| 1225020837 | Terra Jane Laprairie | Nurse Practitioner | 2301 W Kenosha St, Suite 2950, Broken Arrow, OK 74012-8912 | 2005-08-19 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1154949139 | Bonnie Jordan James | Pharmacist | 915 E Kenosha St, Broken Arrow, OK 74012 | 2020-07-07 |
| 1548814874 | Flawless Smile Dentistry of Ba Pllc | Dentist | 2319 N. 9th Street, Broken Arrow, OK 74012 | 2019-07-25 |
| 1780236653 | Carefirst Pharmacy Inc. | Pharmacy | 2530 N. Elm Pl., Broken Arrow, OK 74012 | 2019-07-11 |
| 1043871213 | Stacy Lynn Mitchell | Counselor | 2035 W. Houson St., Suite A, Broken Arrow, OK 74012 | 2019-06-27 |
| 1497319297 | Sara Hart | Internal Medicine | 420 W. Stone Wood Drive, Broken Arrow, OK 74012 | 2019-04-26 |
| 1699262386 | Fulps Family Eye Care, LLC | Optometrist | 3300 S Aspen Ave Ste D, Broken Arrow, OK 74012 | 2018-04-18 |
| 1598284358 | Stephanie Sue Mcquarters | Clinical Medical Laboratory | 1840 South Lion Avenue, Broken Arrow, OK 74012 | 2017-09-13 |
| 1477072460 | Kama Rae Gettings | Nurse Practitioner | 4623 W. Kenosha St, Broken Arrow, OK 74012 | 2017-09-12 |
| 1689196727 | Kristen Sherie' Snyder | Case Manager/Care Coordinator | 1324 North Umbrella Avenue, Broken Arrow, OK 74012 | 2017-07-11 |
| 1699216754 | Hillside Wellness Plllp | Chiropractor | 2311 N 9th St, Suite 101, Broken Arrow, OK 74012 | 2017-03-09 |
| Find all providers in zip 74012 | ||||
| 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 |
|---|---|---|---|---|
| 1154934719 | Suzette Michele Chapple | Pharmacist | 6011 S 15th Pl, Broken Arrow, OK 74011-5101 | 2020-08-24 |
| 1154949139 | Bonnie Jordan James | Pharmacist | 915 E Kenosha St, Broken Arrow, OK 74012 | 2020-07-07 |
| 1659990935 | Rene Lahmbe Tamah | Pharmacist | 4722 S 202nd East Ave, Broken Arrow, OK 74014-8826 | 2020-04-16 |
| 1134775810 | Toan Thanh Nguyen | Pharmacist | 4851 W Houston St, Broken Arrow, OK 74012-4671 | 2019-08-17 |
| 1043704976 | Jessica Heiser | Pharmacist | 2530 N Elm Pl, Broken Arrow, OK 74012-1285 | 2018-06-14 |
| 1063902112 | Jeromy Dionne | Pharmacist | 210 S Elm Pl, Broken Arrow, OK 74012-4033 | 2018-05-15 |
| 1003315052 | Joshua Bryan Crisp | Pharmacist | 1928 W Broadway St, Broken Arrow, OK 74012-8327 | 2018-02-06 |
| 1912411984 | Phebian Arinola Babalola | Pharmacist | 751 W Tucson St, Broken Arrow, OK 74011-7200 | 2017-11-28 |
| 1932570926 | Kimberly Hibbard | Pharmacist | 504 S 64th St, Broken Arrow, OK 74014-2665 | 2015-10-15 |
| 1669712675 | Tamara Jean Cathey-cook | Pharmacist | 8210 S 1st St, Broken Arrow, OK 74011-7019 | 2013-02-28 |
| Find all providers in BROKEN ARROW | ||||
| City | BROKEN ARROW |
| Zip Code | 74012 |
Please comment or provide details below to improve the information on CORY 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.