Provider Demographics
NPI:1184277311
Name:BALLENGEE, SUZANNE RUTH (RPH)
Entity type:Individual
Prefix:MRS
First Name:SUZANNE
Middle Name:RUTH
Last Name:BALLENGEE
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 1:201 N BIRDIE LN
Mailing Address - Street 2:
Mailing Address - City:MONTGOMERY
Mailing Address - State:IN
Mailing Address - Zip Code:47558-5756
Mailing Address - Country:US
Mailing Address - Phone:812-259-5900
Mailing Address - Fax:
Practice Address - Street 1:4040 N NEWTON ST
Practice Address - Street 2:
Practice Address - City:JASPER
Practice Address - State:IN
Practice Address - Zip Code:47546-2575
Practice Address - Country:US
Practice Address - Phone:812-634-1777
Practice Address - Fax:812-634-9810
Is Sole Proprietor?:Yes
Enumeration Date:2019-07-17
Last Update Date:2023-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN26019513A183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist