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General NPI Number Information
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NPI Number | 1184277311
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Entity Type | Individual
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Provider Name | SUZANNE RUTH BALLENGEE R.PH.
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Gender | Female
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Dates
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Enumeration Date | 07/17/2019
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Last Update Date | 11/27/2023
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Provider Practice Location Address
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Address Line | 4040 N NEWTON ST
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City | JASPER
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State | IN
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Zip | 47546-2575
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Country | US
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Telephone | 812-634-1777
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Fax | 812-634-9810
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Provider Business Mailing Address
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Address Line | 201 N BIRDIE LN
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City | MONTGOMERY
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State | IN
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Zip | 47558-5756
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Country | US
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Telephone | 812-259-5900
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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 | 26019513A
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License Number State | IN
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