Provider Demographics
NPI:1326297391
Name:BALLENGER, MICHAEL GEORGE (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:GEORGE
Last Name:BALLENGER
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12010 W 63RD ST
Mailing Address - Street 2:
Mailing Address - City:SHAWNEE
Mailing Address - State:KS
Mailing Address - Zip Code:66216-1867
Mailing Address - Country:US
Mailing Address - Phone:913-268-8150
Mailing Address - Fax:913-268-8479
Practice Address - Street 1:12010 W 63RD ST
Practice Address - Street 2:
Practice Address - City:SHAWNEE
Practice Address - State:KS
Practice Address - Zip Code:66216-1867
Practice Address - Country:US
Practice Address - Phone:913-268-8150
Practice Address - Fax:913-268-8479
Is Sole Proprietor?:No
Enumeration Date:2008-09-15
Last Update Date:2009-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2008013819183500000X
KS1-14321183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist