Provider Demographics
NPI:1164799045
Name:BALL, ANTHONY HENRY (RPH)
Entity Type:Individual
Prefix:MR
First Name:ANTHONY
Middle Name:HENRY
Last Name:BALL
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 1:1019 E CRIMM RD
Mailing Address - Street 2:
Mailing Address - City:SAN TAN VALLEY
Mailing Address - State:AZ
Mailing Address - Zip Code:85143-6782
Mailing Address - Country:US
Mailing Address - Phone:920-238-5595
Mailing Address - Fax:
Practice Address - Street 1:3440 W GLENDALE AVE
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85051-8323
Practice Address - Country:US
Practice Address - Phone:602-336-4590
Practice Address - Fax:602-336-9954
Is Sole Proprietor?:No
Enumeration Date:2011-11-21
Last Update Date:2016-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI11496-40183500000X
AZS021597183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist