MEDICARE: GINA BALLAS 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	21283	MA
2	183500000X	Pharmacist	03406	RI

General Provider Information

NPI Number	:	1598130072
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	GINA BALLAS RPH

Provider Business Mailing Address
First Line	:	11335 SSG SIMS STREET, EAST BLISS
Second Line	:
City	:	EL PASO
State	:	TX
Zip	:	79920-5001
Country	:	US
Telephone Number	:	915-742-1012
Fax Number	:

Provider Business Practice Location Address
First Line	:	11335 SSG SIMS STREET
Second Line	:
City	:	EAST FORT BLISS
State	:	TX
Zip	:	79920-5001
Country	:	US
Telephone Number	:	915-742-1012
Fax Number	:

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

Provider Enumeration Date	:	12/09/2015
Last Update Date	:	12/09/2015

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Directions to “ GINA BALLAS RPH” Practice Location

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