Provider Demographics
NPI:1760051270
Name:BALIQI, EDA (PHARMACIST)
Entity Type:Individual
Prefix:
First Name:EDA
Middle Name:
Last Name:BALIQI
Suffix:
Gender:F
Credentials:PHARMACIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:35 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:PEABODY
Mailing Address - State:MA
Mailing Address - Zip Code:01960-5548
Mailing Address - Country:US
Mailing Address - Phone:978-977-9211
Mailing Address - Fax:978-531-2808
Practice Address - Street 1:35 MAIN ST
Practice Address - Street 2:
Practice Address - City:PEABODY
Practice Address - State:MA
Practice Address - Zip Code:01960-5548
Practice Address - Country:US
Practice Address - Phone:978-977-9211
Practice Address - Fax:978-531-2808
Is Sole Proprietor?:No
Enumeration Date:2021-06-19
Last Update Date:2021-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MAPH239856183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist