MEDICARE: DR. AMBER BALLARD

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	2013029524	MO

General Provider Information

NPI Number	:	1629426887
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. AMBER BALLARD

Provider Business Mailing Address
First Line	:	601 LOCUST ST
Second Line	:
City	:	CHILLICOTHEE
State	:	MO
Zip	:	64601-2250
Country	:	US
Telephone Number	:	660-646-7455
Fax Number	:

Provider Business Practice Location Address
First Line	:	404 S WASHINGTON ST
Second Line	:
City	:	CHILLICOTHEE
State	:	MO
Zip	:	64601-3036
Country	:	US
Telephone Number	:	660-707-0906
Fax Number	:

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

Provider Enumeration Date	:	05/28/2016
Last Update Date	:	10/26/2020

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Directions to “ DR. AMBER BALLARD ” Practice Location

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