MEDICARE: DR. ANGELA BALLANCE 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
1	183500000X	Pharmacist	12844	TN
2	183500000X	Pharmacist	RPH16424	GA
3	183500000X	Pharmacist	12897	NC

General Provider Information

NPI Number	:	1386938488
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ANGELA BALLANCE PHARM.D.

Provider Business Mailing Address
First Line	:	5405 WASHINGTON PIKE
Second Line	:	PHARMACY
City	:	KNOXVILLE
State	:	TN
Zip	:	37918-7004
Country	:	US
Telephone Number	:	865-291-0087
Fax Number	:	865-291-0087

Provider Business Practice Location Address
First Line	:	5405 WASHINGTON PIKE
Second Line	:	PHARMACY
City	:	KNOXVILLE
State	:	TN
Zip	:	37918-7004
Country	:	US
Telephone Number	:	865-291-0087
Fax Number	:	865-291-0087

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

Provider Enumeration Date	:	06/06/2011
Last Update Date	:	06/06/2011

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