Provider Demographics
NPI:1689285397
Name:BALLATORE, ROBIN (PHARMD, MPH)
Entity Type:Individual
Prefix:
First Name:ROBIN
Middle Name:
Last Name:BALLATORE
Suffix:
Gender:F
Credentials:PHARMD, MPH
Other - Prefix:
Other - First Name:ROBIN
Other - Middle Name:
Other - Last Name:DERBY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PHARMD, MPH
Mailing Address - Street 1:8 NW MAIN ST
Mailing Address - Street 2:
Mailing Address - City:WILLISTON
Mailing Address - State:FL
Mailing Address - Zip Code:32696-2043
Mailing Address - Country:US
Mailing Address - Phone:352-528-3409
Mailing Address - Fax:352-528-6459
Practice Address - Street 1:8 NW MAIN ST
Practice Address - Street 2:
Practice Address - City:WILLISTON
Practice Address - State:FL
Practice Address - Zip Code:32696-2043
Practice Address - Country:US
Practice Address - Phone:352-528-3409
Practice Address - Fax:352-528-6459
Is Sole Proprietor?:No
Enumeration Date:2020-08-14
Last Update Date:2020-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS54979183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist