Provider Demographics
NPI:1710521836
Name:BALCERAK, NANCY ANN
Entity Type:Individual
Prefix:
First Name:NANCY
Middle Name:ANN
Last Name:BALCERAK
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5865 PARADISE DR
Mailing Address - Street 2:
Mailing Address - City:MARTINSVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:46151-8463
Mailing Address - Country:US
Mailing Address - Phone:317-422-9030
Mailing Address - Fax:
Practice Address - Street 1:789 STATE ROAD 39 BYP S
Practice Address - Street 2:
Practice Address - City:MARTINSVILLE
Practice Address - State:IN
Practice Address - Zip Code:46151-2127
Practice Address - Country:US
Practice Address - Phone:765-342-2121
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-10-31
Last Update Date:2019-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN26016626A183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes183500000XPharmacy Service ProvidersPharmacistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN26016626AOtherINDIANA BOARD OF PHARMACY