MEDICARE: CHASE BALLINGER PHARMD

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	38265	TN

General Provider Information

NPI Number	:	1366730285
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CHASE BALLINGER PHARMD

Provider Business Mailing Address
First Line	:	9609 CLINGMANS DOME DR
Second Line	:
City	:	KNOXVILLE
State	:	TN
Zip	:	37922-9472
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	4175 S ALAMO AVE
Second Line	:
City	:	DAVIS-MONTHAN AIR FORCE BASE
State	:	AZ
Zip	:	85707
Country	:	US
Telephone Number	:	520-228-1921
Fax Number	:

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

Provider Enumeration Date	:	07/12/2011
Last Update Date	:	05/26/2022

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