MEDICARE: BALES PHARMACY, INC.

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	3336C0003X	Community/Retail Pharmacy	7399	KS

General Provider Information

NPI Number	:	1982764197
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BALES PHARMACY, INC.

Provider Business Mailing Address
First Line	:	116 EAST ROSS ST
Second Line	:
City	:	CLEARWATER
State	:	KS
Zip	:	67026-0459
Country	:	US
Telephone Number	:	620-584-2025
Fax Number	:	620-584-5139

Provider Business Practice Location Address
First Line	:	116 EAST ROSS ST
Second Line	:
City	:	CLEARWATER
State	:	KS
Zip	:	67026-7821
Country	:	US
Telephone Number	:	620-584-2025
Fax Number	:	620-584-5139

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. ROGER A. BALES
Credential	:	RPH
Telephone Number	:	620-584-2025

Provider Enumeration Date	:	12/11/2006
Last Update Date	:	08/22/2020

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