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NPI Code Detail

MEDICARE: JOHNI J BALLOUT

MEDICARE: JOHNI J BALLOUT
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
1183500000XPharmacist80300CA

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
11306880653OTHERNPI

General Provider Information

NPI Number : 1881150944
Entity Type Code : Individual
Provider Name (Legal Business Name) : JOHNI J BALLOUT
Provider Business Mailing Address
First Line : 1736 STATE ST # 437
Second Line :
City : SAN DIEGO
State : CA
Zip : 92101-2513
Country : US
Telephone Number : 619-394-4166
Fax Number :
Provider Business Practice Location Address
First Line : 313 WASHINGTON ST
Second Line :
City : SAN DIEGO
State : CA
Zip : 92103-2109
Country : US
Telephone Number : 619-291-7170
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/13/2019
Last Update Date : 02/13/2019

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Directions to “ JOHNI J BALLOUT ” Practice Location

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