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General NPI Number Information
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NPI Number | 1679484422
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Entity Type | Individual
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Provider Name | CORY BALLEW
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Gender | Male
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Dates
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Enumeration Date | 09/12/2026
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Last Update Date | 09/12/2026
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Provider Practice Location Address
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Address Line | 2836 ROUTE 611
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City | TANNERSVILLE
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State | PA
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Zip | 18372-7922
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Country | US
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Telephone | 570-619-5413
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Fax |
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Provider Business Mailing Address
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Address Line | 2836 ROUTE 611
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City | TANNERSVILLE
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State | PA
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Zip | 18372-7922
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Country | US
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Telephone | 570-619-5413
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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 | 183700000X
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Taxonomy Name | Pharmacy Technician
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License Number | PTE005878
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License Number State | PA
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