MEDICARE: MRS. CONNIE CHI BALEN RPH.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	183500000X	Pharmacist	45999	CA

General Provider Information

NPI Number	:	1063690519
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. CONNIE CHI BALEN RPH.

Provider Business Mailing Address
First Line	:	15079 LEVITA CT
Second Line	:
City	:	POWAY
State	:	CA
Zip	:	92064-2432
Country	:	US
Telephone Number	:	858-748-7804
Fax Number	:

Provider Business Practice Location Address
First Line	:	11939 RANCHO BERNARDO RD
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92128-2073
Country	:	US
Telephone Number	:	858-674-2365
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/07/2008
Last Update Date	:	02/07/2008

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