Healthcare Provider Details

I. General information

NPI: 1255873436
Provider Name (Legal Business Name): ABIGAIL M BALTZ PHARMD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/05/2016
Last Update Date: 11/05/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10 SNYDER AVE
PHILADELPHIA PA
19148-2700
US

IV. Provider business mailing address

10 SNYDER AVE
PHILADELPHIA PA
19148-2700
US

V. Phone/Fax

Practice location:
  • Phone: 215-465-3270
  • Fax:
Mailing address:
  • Phone: 215-465-3270
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberRP451190
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: