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General NPI Number Information
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NPI Number | 1881150944
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Entity Type | Individual
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Provider Name | JOHNI J BALLOUT
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Gender | Male
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Dates
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Enumeration Date | 02/13/2019
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Last Update Date | 02/13/2019
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Provider Practice Location Address
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Address Line | 313 WASHINGTON ST
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City | SAN DIEGO
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State | CA
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Zip | 92103-2109
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Country | US
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Telephone | 619-291-7170
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Fax |
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Provider Business Mailing Address
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Address Line | 1736 STATE ST # 437
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City | SAN DIEGO
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State | CA
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Zip | 92101-2513
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Country | US
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Telephone | 619-394-4166
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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 | 80300
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License Number State | CA
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