Basic Information
| Provider Information | |||||||||
| NPI: | 1437287943 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | WALLIN-WAIS | ||||||||
| FirstName: | JO | ||||||||
| MiddleName: | LYNNE | ||||||||
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| Credential: | PHARM.D., BCPS | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2308 W ROGERS AVE | ||||||||
| Address2: | |||||||||
| City: | BALTIMORE | ||||||||
| State: | MD | ||||||||
| PostalCode: | 212094426 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4106648717 | ||||||||
| FaxNumber: | 4438493447 | ||||||||
| Practice Location | |||||||||
| Address1: | 5701 N CHARLES ST | ||||||||
| Address2: | SUITE 5218 | ||||||||
| City: | BALTIMORE | ||||||||
| State: | MD | ||||||||
| PostalCode: | 212101315 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4438493786 | ||||||||
| FaxNumber: | 4438498447 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/28/2007 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 1835P1200X | 11560 | MD | Y | Pharmacy Service Providers | Pharmacist | Pharmacotherapy |
No ID Information.