Healthcare Provider Details

I. General information

NPI: 1821104860
Provider Name (Legal Business Name): GREGORY EARL BALL RPH
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/22/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

128 REDBUD HIGHWAY
HONAKER VA
24260
US

IV. Provider business mailing address

PO BOX 637
ROSEDALE VA
24280-0637
US

V. Phone/Fax

Practice location:
  • Phone: 276-873-6134
  • Fax: 276-873-4614
Mailing address:
  • Phone: 276-880-2061
  • Fax: 276-873-4614

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number0202011005
License Number StateVA
# 2
Primary TaxonomyN
Taxonomy Code183500000X
TaxonomyPharmacist
License Number0000012052
License Number StateTN
# 3
Primary TaxonomyN
Taxonomy Code183500000X
TaxonomyPharmacist
License Number012321
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: