Provider Demographics
NPI:1164583688
Name:BALLARD, RALPH E (RPH, MBA)
Entity Type:Individual
Prefix:MR
First Name:RALPH
Middle Name:E
Last Name:BALLARD
Suffix:
Gender:M
Credentials:RPH, MBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1305 CORPORATE CENTER DR
Mailing Address - Street 2:
Mailing Address - City:EAGAN
Mailing Address - State:MN
Mailing Address - Zip Code:55121-1204
Mailing Address - Country:US
Mailing Address - Phone:612-777-5176
Mailing Address - Fax:612-777-5141
Practice Address - Street 1:1313 PENN AVE N
Practice Address - Street 2:PHARMACY
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55411-3047
Practice Address - Country:US
Practice Address - Phone:612-302-4600
Practice Address - Fax:612-302-4663
Is Sole Proprietor?:No
Enumeration Date:2006-12-12
Last Update Date:2008-11-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN116707-8183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN116707-8OtherMN BOARD OF PHARMACY LIC.