Provider Demographics
NPI:1851425011
Name:BALTZLY WEST INCORPORATED
Entity Type:Organization
Organization Name:BALTZLY WEST INCORPORATED
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHARMACIST
Authorized Official - Prefix:
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:E
Authorized Official - Last Name:DAVIES
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:330-833-4113
Mailing Address - Street 1:2208 LINCOLN WAY NW
Mailing Address - Street 2:
Mailing Address - City:MASSILLON
Mailing Address - State:OH
Mailing Address - Zip Code:44647-6144
Mailing Address - Country:US
Mailing Address - Phone:330-833-4113
Mailing Address - Fax:
Practice Address - Street 1:2208 LINCOLN WAY NW
Practice Address - Street 2:
Practice Address - City:MASSILLON
Practice Address - State:OH
Practice Address - Zip Code:44647-6144
Practice Address - Country:US
Practice Address - Phone:330-833-4113
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-16
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH3336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy