Provider Demographics
NPI:1760040968
Name:BALILE, SAMIR (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:SAMIR
Middle Name:
Last Name:BALILE
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1537 8TH ST NW
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20001-3205
Mailing Address - Country:US
Mailing Address - Phone:571-435-2028
Mailing Address - Fax:
Practice Address - Street 1:8301 PROFESSIONAL PL STE 115
Practice Address - Street 2:
Practice Address - City:LANDOVER
Practice Address - State:MD
Practice Address - Zip Code:20785-2351
Practice Address - Country:US
Practice Address - Phone:202-819-9989
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-06-03
Last Update Date:2019-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA02022123043336C0003X
DCPH1000021293336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy