Provider Demographics
NPI:1457312381
Name:BALI HOPPI, PAMELA O (RPH)
Entity Type:Individual
Prefix:
First Name:PAMELA
Middle Name:O
Last Name:BALI HOPPI
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 1:1 CELTIC DR
Mailing Address - Street 2:
Mailing Address - City:NANTUCKET
Mailing Address - State:MA
Mailing Address - Zip Code:02554-4391
Mailing Address - Country:US
Mailing Address - Phone:508-680-1004
Mailing Address - Fax:
Practice Address - Street 1:5 BAYBERRY CT
Practice Address - Street 2:
Practice Address - City:NANTUCKET
Practice Address - State:MA
Practice Address - Zip Code:02554-4038
Practice Address - Country:US
Practice Address - Phone:508-825-9100
Practice Address - Fax:508-825-2154
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-03-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA16744183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist