Provider Demographics
NPI:1760104681
Name:BALAMOUN, ARSANUOS (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:ARSANUOS
Middle Name:
Last Name:BALAMOUN
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 1:3301 VINTAGE CIR SE
Mailing Address - Street 2:
Mailing Address - City:SMYRNA
Mailing Address - State:GA
Mailing Address - Zip Code:30080-4596
Mailing Address - Country:US
Mailing Address - Phone:919-389-8973
Mailing Address - Fax:
Practice Address - Street 1:3301 VINTAGE CIR SE
Practice Address - Street 2:
Practice Address - City:SMYRNA
Practice Address - State:GA
Practice Address - Zip Code:30080-4596
Practice Address - Country:US
Practice Address - Phone:919-389-8973
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-09-16
Last Update Date:2022-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARPH033956183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist