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General NPI Number Information
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NPI Number | 1629347679
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Entity Type | Individual
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Provider Name | YVETTE MARIE BALLOU PHARMD
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Gender | Female
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Dates
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Enumeration Date | 12/20/2011
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Last Update Date | 12/20/2011
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Provider Practice Location Address
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Address Line | 16000 N CLEVELAND AVE
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City | NORTH FORT MYERS
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State | FL
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Zip | 33903-2107
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Country | US
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Telephone | 239-656-3419
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Fax |
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Provider Business Mailing Address
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Address Line | 8761 WESLEYAN DR 1714
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City | FORT MYERS
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State | FL
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Zip | 33919-3295
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Country | US
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Telephone | 440-213-5752
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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 | PS46827
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License Number State | FL
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