Provider Demographics
NPI:1821104860
Name:BALL, GREGORY EARL (RPH)
Entity Type:Individual
Prefix:MR
First Name:GREGORY
Middle Name:EARL
Last Name:BALL
Suffix:
Gender:M
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:PO BOX 637
Mailing Address - Street 2:
Mailing Address - City:ROSEDALE
Mailing Address - State:VA
Mailing Address - Zip Code:24280-0637
Mailing Address - Country:US
Mailing Address - Phone:276-880-2061
Mailing Address - Fax:276-873-4614
Practice Address - Street 1:128 REDBUD HIGHWAY
Practice Address - Street 2:
Practice Address - City:HONAKER
Practice Address - State:VA
Practice Address - Zip Code:24260
Practice Address - Country:US
Practice Address - Phone:276-873-6134
Practice Address - Fax:276-873-4614
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0202011005183500000X
TN0000012052183500000X
KY012321183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist