Provider Demographics
NPI:1346517547
Name:BALES, ELIZABETH ANN (PHARMD RPH)
Entity Type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:ANN
Last Name:BALES
Suffix:
Gender:F
Credentials:PHARMD RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2455 EASTERN AVE
Mailing Address - Street 2:
Mailing Address - City:PLYMOUTH
Mailing Address - State:WI
Mailing Address - Zip Code:53073-4240
Mailing Address - Country:US
Mailing Address - Phone:920-893-5895
Mailing Address - Fax:920-893-5898
Practice Address - Street 1:2455 EASTERN AVE
Practice Address - Street 2:
Practice Address - City:PLYMOUTH
Practice Address - State:WI
Practice Address - Zip Code:53073-4240
Practice Address - Country:US
Practice Address - Phone:920-893-5895
Practice Address - Fax:920-893-5898
Is Sole Proprietor?:No
Enumeration Date:2011-11-16
Last Update Date:2023-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI15228-40183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist