Provider Demographics
NPI:1164771754
Name:BALMIR, CARL A (PHARM D)
Entity Type:Individual
Prefix:DR
First Name:CARL
Middle Name:A
Last Name:BALMIR
Suffix:
Gender:M
Credentials:PHARM D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9372 RICHMOND HWY
Mailing Address - Street 2:
Mailing Address - City:LORTON
Mailing Address - State:VA
Mailing Address - Zip Code:22079-1827
Mailing Address - Country:US
Mailing Address - Phone:571-642-0103
Mailing Address - Fax:
Practice Address - Street 1:9372 RICHMOND HWY
Practice Address - Street 2:
Practice Address - City:LORTON
Practice Address - State:VA
Practice Address - Zip Code:22079-1827
Practice Address - Country:US
Practice Address - Phone:571-642-0103
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-08-29
Last Update Date:2015-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCPH100001914183500000X
VA0202211741183500000X
FLPS54222183500000X
MD23241183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist