Healthcare Provider Details

I. General information

NPI: 1346553906
Provider Name (Legal Business Name): JESSICA BALLINGER PHARMD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/23/2010
Last Update Date: 07/23/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2574 EASTON ST NE
CANTON OH
44721-2662
US

IV. Provider business mailing address

2812 AUTUMN ST NW
MASSILLON OH
44647-8639
US

V. Phone/Fax

Practice location:
  • Phone: 330-492-6203
  • Fax:
Mailing address:
  • Phone: 330-232-2942
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number03230104
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: