Provider Demographics
NPI:1376640912
Name:BALAS, DONALD SYMES (RPH)
Entity Type:Individual
Prefix:
First Name:DONALD
Middle Name:SYMES
Last Name:BALAS
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 1:2830 S RIVER RD
Mailing Address - Street 2:
Mailing Address - City:CEDARVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:45314-9739
Mailing Address - Country:US
Mailing Address - Phone:937-767-2638
Mailing Address - Fax:937-426-2535
Practice Address - Street 1:3245 SEAJAY DR
Practice Address - Street 2:C/O LOFINO'S PHARMACY
Practice Address - City:BEAVERCREEK
Practice Address - State:OH
Practice Address - Zip Code:45430-1356
Practice Address - Country:US
Practice Address - Phone:937-426-0060
Practice Address - Fax:937-426-2535
Is Sole Proprietor?:No
Enumeration Date:2006-09-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH03-2-11246183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist