Provider Demographics
NPI:1013912765
Name:BALTZ, DOUGLAS A (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:DOUGLAS
Middle Name:A
Last Name:BALTZ
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 1:642 W STRAWN AVE
Mailing Address - Street 2:
Mailing Address - City:JONESBORO
Mailing Address - State:AR
Mailing Address - Zip Code:72401-3982
Mailing Address - Country:US
Mailing Address - Phone:870-935-0294
Mailing Address - Fax:
Practice Address - Street 1:642 W STRAWN AVE
Practice Address - Street 2:
Practice Address - City:JONESBORO
Practice Address - State:AR
Practice Address - Zip Code:72401-3982
Practice Address - Country:US
Practice Address - Phone:870-935-0294
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-06-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR6612183500000X, 1835P1200X, 1835P1300X
MO2000165328183500000X, 1835P1200X, 1835P1300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered183500000XPharmacy Service ProvidersPharmacist
Not Answered1835P1200XPharmacy Service ProvidersPharmacistPharmacotherapy
Not Answered1835P1300XPharmacy Service ProvidersPharmacistPsychiatric