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NPI Code Detail

MEDICARE: AMY ANN BALOG PHARM.D

MEDICARE: AMY ANN BALOG PHARM.D
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
1183500000XPharmacist68008CA

General Provider Information

NPI Number : 1225475411
Entity Type Code : Individual
Provider Name (Legal Business Name) : AMY ANN BALOG PHARM.D
Provider Business Mailing Address
First Line : 60 N HIGHLAND SPRINGS AVE
Second Line :
City : BANNING
State : CA
Zip : 92220-3048
Country : US
Telephone Number : 951-845-5984
Fax Number : 951-845-7845
Provider Business Practice Location Address
First Line : 60 N HIGHLAND SPRINGS AVE
Second Line :
City : BANNING
State : CA
Zip : 92220-3048
Country : US
Telephone Number : 951-845-5984
Fax Number : 951-845-7845
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/28/2013
Last Update Date : 05/28/2013

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