Provider Demographics
NPI:1073685558
Name:BALLING, DANIEL B (RPH)
Entity Type:Individual
Prefix:
First Name:DANIEL
Middle Name:B
Last Name:BALLING
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:66 FAIRGROUNDS RD
Mailing Address - Street 2:
Mailing Address - City:NANTUCKET
Mailing Address - State:MA
Mailing Address - Zip Code:02554-2804
Mailing Address - Country:US
Mailing Address - Phone:508-228-7495
Mailing Address - Fax:
Practice Address - Street 1:5 BAYBERRY CT
Practice Address - Street 2:
Practice Address - City:NANTUCKET
Practice Address - State:MA
Practice Address - Zip Code:02554-4057
Practice Address - Country:US
Practice Address - Phone:508-825-9100
Practice Address - Fax:508-825-2154
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA20362183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA20362OtherRPH LICENSE