Healthcare Provider Details

I. General information

NPI: 1437448016
Provider Name (Legal Business Name): MARYANN DEBALKO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/04/2011
Last Update Date: 04/04/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

524 N 6TH ST
READING PA
19601-3012
US

IV. Provider business mailing address

42 RIDGE CREST DR
FLEETWOOD PA
19522-8874
US

V. Phone/Fax

Practice location:
  • Phone: 610-374-6282
  • Fax:
Mailing address:
  • Phone: 610-944-6417
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberRP045934L
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: