Healthcare Provider Details

I. General information

NPI: 1255003919
Provider Name (Legal Business Name): GRACE BALLINGER PHARMD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/01/2021
Last Update Date: 05/31/2026
Certification Date: 05/31/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

601 E DUPONT RD
FORT WAYNE IN
46825-2055
US

IV. Provider business mailing address

15341 BEARS BREECH CT
HUNTERTOWN IN
46748-9152
US

V. Phone/Fax

Practice location:
  • Phone: 260-637-6115
  • Fax:
Mailing address:
  • Phone: 260-571-8029
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1835P0018X
TaxonomyPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
License Number26029306A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: