National Provider Identifier
Krystal A Wallis, PHARM D
Krystal A Wallis, PHARM D is listed in the NPPES registry with a primary specialty of Pharmacist in Brockport, NY and a listed phone number of (585) 637-2341.
Profile Overview
- NPI
- 1720334329
- Provider Type
- Individual
- Primary Specialty
- Pharmacist
- Enumeration Date
- August 01, 2012
- Last Updated
- June 05, 2013
Practice Location
- 6265 Brockport Spencerport RD
- Brockport, NY 14420-2605
Phone: (585) 637-2341
Specialties
- Pharmacist (183500000X)
Full Record
- NPI
- 1720334329
- Entity Type
- Individual
- Last Name
- Wallis
- First Name
- Krystal
- Middle Name
- A
- Credential
- PHARM D
- Provider Other Last Name
- Mellema
- Provider Other First Name
- Krystal
- Provider Other Middle Name
- A
- Provider Other Credential Text
- PHARM D
- Provider Other Last Name Type Code
- 1
- Mailing Street Address
- 6265 Brockport Spencerport RD
- Mailing City
- Brockport
- Mailing State
- NY
- Mailing ZIP Code
- 14420-2605
- Mailing Country
- US
- Mailing Phone
- (585) 637-2341
- Mailing Fax
- (585) 637-9914
- Practice Street Address
- 6265 Brockport Spencerport RD
- Practice City
- Brockport
- Practice State
- NY
- Practice ZIP Code
- 14420-2605
- Practice Country
- US
- Practice Phone
- (585) 637-2341
- Practice Fax
- (585) 637-9914
- Enumeration Date
- August 01, 2012
- Last Updated
- June 05, 2013
- Sex
- Female
- Sole Proprietor
- Yes
- updated_by_file
- npidata_pfile_20050523-20260308.csv
- Taxonomies
- Pharmacist (183500000X)