Provider Demographics
NPI:1497002893
Name:BALANDA, MICHELL (PHARMD, BCPS)
Entity Type:Individual
Prefix:DR
First Name:MICHELL
Middle Name:
Last Name:BALANDA
Suffix:
Gender:F
Credentials:PHARMD, BCPS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7377 ALCOA RD
Mailing Address - Street 2:T-2204
Mailing Address - City:BRYANT
Mailing Address - State:AR
Mailing Address - Zip Code:72022-6204
Mailing Address - Country:US
Mailing Address - Phone:501-776-4361
Mailing Address - Fax:
Practice Address - Street 1:7377 ALCOA RD
Practice Address - Street 2:T-2204
Practice Address - City:BRYANT
Practice Address - State:AR
Practice Address - Zip Code:72022-6204
Practice Address - Country:US
Practice Address - Phone:501-776-4361
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-08-06
Last Update Date:2012-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARPD11901183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR161991407Medicaid