Provider Demographics
NPI:1689989790
Name:BALLIER, CARL A (PHARMACIST)
Entity Type:Individual
Prefix:MR
First Name:CARL
Middle Name:A
Last Name:BALLIER
Suffix:
Gender:M
Credentials:PHARMACIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1321 CHESTNUT AVE
Mailing Address - Street 2:
Mailing Address - City:HADDON HEIGHTS
Mailing Address - State:NJ
Mailing Address - Zip Code:08035-1842
Mailing Address - Country:US
Mailing Address - Phone:856-546-7441
Mailing Address - Fax:
Practice Address - Street 1:501 CLEMENTS BRIDGE RD
Practice Address - Street 2:
Practice Address - City:BARRINGTON
Practice Address - State:NJ
Practice Address - Zip Code:08007-1811
Practice Address - Country:US
Practice Address - Phone:856-547-3200
Practice Address - Fax:856-547-5283
Is Sole Proprietor?:Yes
Enumeration Date:2010-08-12
Last Update Date:2010-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ28R101234600183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ183500000XOtherPHARMACIST