Jovante Antwon Wallace, PHARM.D.
NPI 1063175842ActiveIndividual· Pharmacist· Lombard, IL
Pharmacist (PHARM.D.) in Lombard, Illinois, licensed in IL, WI and TX, with an NPI issued in October 2021.
Overview
| NPI | 1063175842 |
|---|---|
| Status | Active |
| Entity type | Individual |
| Credential | PHARM.D. |
| Sole proprietor | No |
| NPI issued | Oct 18, 2021 |
| Last updated in NPPES | Oct 18, 2021 |
| Certified by provider | Oct 18, 2021 |
Specialties and licenses
| Taxonomy | Code | License | State |
|---|---|---|---|
| Pharmacist Primary | 183500000X | 051300907 | IL |
| Pharmacist | 183500000X | 19222-40 | WI |
| Pharmacist | 183500000X | 26027447A | WI |
| Pharmacist | 183500000X | 65475 | TX |
Exclusion screening
| List | Result | Details |
|---|---|---|
| HHS-OIG LEIE · Nov 10, 2026 | No match | Checked by NPI and by name + state |
| North Carolina Medicaid · Nov 11, 2026 | No match | — |
| New York OMIG · Nov 11, 2026 | No match | — |
| Ohio Medicaid · Nov 11, 2026 | No match | — |
| Pennsylvania Medicheck · Nov 11, 2026 | No match | — |
| Washington HCA · Nov 11, 2026 | No match | — |
Official OIG search · How matching works ·Bulk check a roster
Medicare
| Enrollment (PECOS) | Not in the public enrollment file of Oct 1, 2026 |
|---|
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