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General NPI Number Information
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NPI Number | 1962323436
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Entity Type | Individual
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Provider Name | GHAITH BALLICH
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Gender | Male
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Dates
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Enumeration Date | 07/22/2026
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Last Update Date | 07/22/2026
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Provider Practice Location Address
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Address Line | 5502 E FOWLER AVE
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City | TEMPLE TERRACE
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State | FL
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Zip | 33617-2226
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Country | US
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Telephone | 813-984-1560
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Fax |
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Provider Business Mailing Address
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Address Line | 12801 REAL MADRID LN
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City | TAMPA
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State | FL
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Zip | 33617-1345
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Country | US
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Telephone |
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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 | PSI44991
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License Number State | FL
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