Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.

Shanise Wallace

Individual provider Pharmacist · NPI 1114552445

Shanise Wallace is a Pharmacist in Kenosha, Wisconsin. Practices as a sole proprietor. Licensed in Wisconsin.

Licensed in
WI
In the registry since
2020

Practice location Address checks out

3710 57th Ave
Kenosha, WI 53144-4820
Phone: (262) 652-1474
Show map & directions

Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Pharmacist (primary) Taxonomy 183500000X · Licence 17696-40 (WI)

Record details

NPI number1114552445
Entity typeIndividual (Type 1)
GenderFemale
Sole proprietorYes
NPI enumeratedMarch 6, 2020
Last updated in NPPESMarch 6, 2020
Certification dateMarch 6, 2020
Mailing address3710 57th Ave, Kenosha, WI 53144-4820

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