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General NPI Number Information
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NPI Number | 1104116854
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Entity Type | Individual
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Provider Name | LEWIS BALLA
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Gender | Male
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Dates
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Enumeration Date | 04/14/2011
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Last Update Date | 04/14/2011
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Provider Practice Location Address
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Address Line | 610 BROAD ST
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City | NEW BETHLEHEM
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State | PA
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Zip | 16242-1106
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Country | US
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Telephone | 814-275-4241
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Fax |
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Provider Business Mailing Address
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Address Line | 3304 RIVERFRONT DR
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City | PITTSBURGH
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State | PA
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Zip | 15238-3186
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 183500000X
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Taxonomy Name | Pharmacist
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License Number | RP027108L
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License Number State | PA
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