Healthcare Provider Details

I. General information

NPI: 1770408619
Provider Name (Legal Business Name): MADISON PAIGE BALOG PHARMD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/11/2026
Last Update Date: 08/11/2026
Certification Date: 08/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1625 N 44TH ST
PHOENIX AZ
85008-4114
US

IV. Provider business mailing address

2829 W MARSHALL AVE
PHOENIX AZ
85017-2621
US

V. Phone/Fax

Practice location:
  • Phone: 602-275-0120
  • Fax:
Mailing address:
  • Phone: 724-980-4730
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberS028032
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: