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General NPI Number Information
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NPI Number | 1750534269
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Entity Type | Individual
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Provider Name | ANGELA BALASCAK R.PH., CGP
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Gender | Female
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Dates
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Enumeration Date | 10/28/2008
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Last Update Date | 05/31/2011
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Provider Practice Location Address
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Address Line | 1000 FIANNA WAY
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City | FORT SMITH
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State | AR
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Zip | 72919-6987
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Country | US
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Telephone | 651-260-8461
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Fax |
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Provider Business Mailing Address
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Address Line | 4663 PINE CONE CIR
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City | EAGAN
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State | MN
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Zip | 55123-5401
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Country | US
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Telephone | 651-260-8461
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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 | 118486
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License Number State | MN
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Taxonomy #2
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Taxonomy Code | 183500000X
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Taxonomy Name | Pharmacist
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License Number | 43048
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License Number State | TX
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