Provider Demographics
NPI:1417939919
Name:BALOG, STACI M (RPH)
Entity Type:Individual
Prefix:MRS
First Name:STACI
Middle Name:M
Last Name:BALOG
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:209 ALTERMOOR DR
Mailing Address - Street 2:
Mailing Address - City:NATRONA HEIGHTS
Mailing Address - State:PA
Mailing Address - Zip Code:15065-9724
Mailing Address - Country:US
Mailing Address - Phone:724-295-1150
Mailing Address - Fax:
Practice Address - Street 1:1215 HULTON RD
Practice Address - Street 2:
Practice Address - City:OAKMONT
Practice Address - State:PA
Practice Address - Zip Code:15139-1135
Practice Address - Country:US
Practice Address - Phone:412-826-6032
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-11-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARP040576L183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist