Provider Demographics
NPI:1558705509
Name:BALZER, TERRY T (RPH)
Entity Type:Individual
Prefix:MR
First Name:TERRY
Middle Name:T
Last Name:BALZER
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7701 ACAPULCO RD
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76112-6114
Mailing Address - Country:US
Mailing Address - Phone:817-875-3382
Mailing Address - Fax:
Practice Address - Street 1:7701 ACAPULCO RD
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76112-6114
Practice Address - Country:US
Practice Address - Phone:817-875-3382
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-04-22
Last Update Date:2013-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX20933183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist