MEDICARE: VINCE R BALAGA

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	183700000X	Pharmacy Technician	0230039921	VA

General Provider Information

NPI Number	:	1679266035
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	VINCE R BALAGA

Provider Business Mailing Address
First Line	:	168 JOHN PAUL JONES DR
Second Line	:
City	:	RUTHER GLEN
State	:	VA
Zip	:	22546-5048
Country	:	US
Telephone Number	:	540-642-6800
Fax Number	:

Provider Business Practice Location Address
First Line	:	168 JOHN PAUL JONES DR
Second Line	:
City	:	RUTHER GLEN
State	:	VA
Zip	:	22546-5048
Country	:	US
Telephone Number	:	540-642-6800
Fax Number	:

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

Provider Enumeration Date	:	06/01/2023
Last Update Date	:	06/01/2023

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