Healthcare Provider Details

I. General information

NPI: 1982764197
Provider Name (Legal Business Name): BALES PHARMACY, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/11/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

116 EAST ROSS ST
CLEARWATER KS
67026-7821
US

IV. Provider business mailing address

116 EAST ROSS ST
CLEARWATER KS
67026-0459
US

V. Phone/Fax

Practice location:
  • Phone: 620-584-2025
  • Fax: 620-584-5139
Mailing address:
  • Phone: 620-584-2025
  • Fax: 620-584-5139

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number7399
License Number StateKS

VIII. Authorized Official

Name: DR. ROGER A. BALES
Title or Position: PRESIDENT
Credential: RPH
Phone: 620-584-2025