Provider Demographics
NPI:1508201922
Name:BALAS, WILLIAM (R PH)
Entity Type:Individual
Prefix:
First Name:WILLIAM
Middle Name:
Last Name:BALAS
Suffix:
Gender:M
Credentials:R PH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:111 S 11TH ST
Mailing Address - Street 2:1850 GIBBON BIULDING
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19107-4824
Mailing Address - Country:US
Mailing Address - Phone:215-955-9218
Mailing Address - Fax:215-955-1711
Practice Address - Street 1:111 S 11TH ST
Practice Address - Street 2:1850 GIBBON BIULDING
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19107-4824
Practice Address - Country:US
Practice Address - Phone:215-955-9218
Practice Address - Fax:215-955-1711
Is Sole Proprietor?:Yes
Enumeration Date:2013-04-30
Last Update Date:2013-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARP-032089-L183500000X
NJRI-16619183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist