Provider Demographics
NPI:1205411139
Name:BALLINGER, JEANINE (PHARM D)
Entity Type:Individual
Prefix:DR
First Name:JEANINE
Middle Name:
Last Name:BALLINGER
Suffix:
Gender:F
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 1:720 MUSTANG CT
Mailing Address - Street 2:
Mailing Address - City:WINTER SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:32708-4512
Mailing Address - Country:US
Mailing Address - Phone:321-277-1910
Mailing Address - Fax:
Practice Address - Street 1:5650 RED BUG LAKE RD
Practice Address - Street 2:
Practice Address - City:WINTER SPRINGS
Practice Address - State:FL
Practice Address - Zip Code:32708-4904
Practice Address - Country:US
Practice Address - Phone:407-699-0781
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-03-11
Last Update Date:2021-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS28522183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist