1437287943 NPI number — JO LYNNE WALLIN-WAIS PHARM.D., BCPS

Table of content: JO LYNNE WALLIN-WAIS PHARM.D., BCPS (NPI 1437287943)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1437287943 NPI number — JO LYNNE WALLIN-WAIS PHARM.D., BCPS

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
WALLIN-WAIS
Provider First Name:
JO
Provider Middle Name:
LYNNE
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
PHARM.D., BCPS
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1437287943
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2308 W ROGERS AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BALTIMORE
Provider Business Mailing Address State Name:
MD
Provider Business Mailing Address Postal Code:
21209-4426
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
410-664-8717
Provider Business Mailing Address Fax Number:
443-849-3447

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
5701 N CHARLES ST
Provider Second Line Business Practice Location Address:
SUITE 5218
Provider Business Practice Location Address City Name:
BALTIMORE
Provider Business Practice Location Address State Name:
MD
Provider Business Practice Location Address Postal Code:
21210-1315
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
443-849-3786
Provider Business Practice Location Address Fax Number:
443-849-8447
Provider Enumeration Date:
02/28/2007

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 1835P1200X , with the licence number:  11560 , registered in the state of MD ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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