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NPI Code Detail

MEDICARE: RALPH DONALD BALLARD RPH

MEDICARE: RALPH DONALD BALLARD 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
1183500000XPharmacist27145TX

General Provider Information

NPI Number : 1083214100
Entity Type Code : Individual
Provider Name (Legal Business Name) : RALPH DONALD BALLARD RPH
Provider Business Mailing Address
First Line : 4810 NORTH ST
Second Line :
City : NACOGDOCHES
State : TX
Zip : 75965-1876
Country : US
Telephone Number : 936-564-1158
Fax Number : 936-564-1035
Provider Business Practice Location Address
First Line : 4810 NORTH ST
Second Line :
City : NACOGDOCHES
State : TX
Zip : 75965-1876
Country : US
Telephone Number : 936-564-1158
Fax Number : 936-564-1035
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/28/2020
Last Update Date : 10/28/2020

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