Provider Demographics
NPI:1609198522
Name:HASSELBALCH, BARRIE A (RPH)
Entity Type:Individual
Prefix:
First Name:BARRIE
Middle Name:A
Last Name:HASSELBALCH
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 1:4340 E INDIAN SCHOOL RD
Mailing Address - Street 2:#566
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85018-5360
Mailing Address - Country:US
Mailing Address - Phone:602-692-1208
Mailing Address - Fax:
Practice Address - Street 1:4340 E INDIAN SCHOOL RD
Practice Address - Street 2:#566
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85018-5360
Practice Address - Country:US
Practice Address - Phone:602-692-1208
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-02-19
Last Update Date:2010-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZS012964183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist