Healthcare Provider Details

I. General information

NPI: 1801981998
Provider Name (Legal Business Name): DANIEL JONATHAN BALISH PHARM.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/04/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

404 N FRUITLAND BLVD
SALISBURY MD
21801-7261
US

IV. Provider business mailing address

148 FRANCIS DR
SALISBURY MD
21804-6903
US

V. Phone/Fax

Practice location:
  • Phone: 410-749-8401
  • Fax: 410-860-1155
Mailing address:
  • Phone: 410-548-1644
  • Fax: 410-860-1155

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1835G0303X
TaxonomyGeriatric Pharmacist
License Number10708
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: