Provider Demographics
NPI:1477624641
Name:BALLARD, RAY A (RPH)
Entity Type:Individual
Prefix:MR
First Name:RAY
Middle Name:A
Last Name:BALLARD
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:6770 DIXIE HWY
Mailing Address - Street 2:SUITE 201
Mailing Address - City:CLARKSTON
Mailing Address - State:MI
Mailing Address - Zip Code:48346-2087
Mailing Address - Country:US
Mailing Address - Phone:248-620-3588
Mailing Address - Fax:248-620-0037
Practice Address - Street 1:6770 DIXIE HWY
Practice Address - Street 2:SUITE 201
Practice Address - City:CLARKSTON
Practice Address - State:MI
Practice Address - Zip Code:48346-2087
Practice Address - Country:US
Practice Address - Phone:248-620-3588
Practice Address - Fax:248-620-0037
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5302022863183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist