Provider Demographics
NPI:1790089233
Name:BALLARD, JANET G (RPH)
Entity Type:Individual
Prefix:
First Name:JANET
Middle Name:G
Last Name:BALLARD
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11400 W HUGUENOT RD
Mailing Address - Street 2:
Mailing Address - City:MIDLOTHIAN
Mailing Address - State:VA
Mailing Address - Zip Code:23113-1193
Mailing Address - Country:US
Mailing Address - Phone:804-379-2496
Mailing Address - Fax:804-379-7845
Practice Address - Street 1:11400 W HUGUENOT RD
Practice Address - Street 2:
Practice Address - City:MIDLOTHIAN
Practice Address - State:VA
Practice Address - Zip Code:23113-1193
Practice Address - Country:US
Practice Address - Phone:804-379-2496
Practice Address - Fax:804-379-7845
Is Sole Proprietor?:No
Enumeration Date:2010-12-25
Last Update Date:2010-12-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0202204385183500000X
VT033-0002973183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist