Provider Demographics
NPI:1508188863
Name:BALOG, KRISTINA J (RPH)
Entity Type:Individual
Prefix:
First Name:KRISTINA
Middle Name:J
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 1:16086 CONNEAUT LAKE RD
Mailing Address - Street 2:
Mailing Address - City:MEADVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:16335-3884
Mailing Address - Country:US
Mailing Address - Phone:814-724-6351
Mailing Address - Fax:814-724-6353
Practice Address - Street 1:16086 CONNEAUT LAKE RD
Practice Address - Street 2:
Practice Address - City:MEADVILLE
Practice Address - State:PA
Practice Address - Zip Code:16335-3884
Practice Address - Country:US
Practice Address - Phone:814-724-6351
Practice Address - Fax:814-724-6353
Is Sole Proprietor?:Yes
Enumeration Date:2010-02-26
Last Update Date:2010-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARP041447R183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist