Healthcare Provider Details

I. General information

NPI: 1245393867
Provider Name (Legal Business Name): CARRIE JEAN BALL PHARM.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/18/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1423 N JEFFERSON AVE
SPRINGFIELD MO
65802-1917
US

IV. Provider business mailing address

322 S RIVER BIRCH DR
SPRINGFIELD MO
65809-3306
US

V. Phone/Fax

Practice location:
  • Phone: 417-269-3418
  • Fax:
Mailing address:
  • Phone: 417-866-2866
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number045246
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: