Provider Demographics
NPI:1295057073
Name:BALLACK, HEATHER VARGO (PHARMD)
Entity type:Individual
Prefix:MRS
First Name:HEATHER
Middle Name:VARGO
Last Name:BALLACK
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7235 W. 79TH STREET
Mailing Address - Street 2:
Mailing Address - City:BRIDGEVIEW
Mailing Address - State:IL
Mailing Address - Zip Code:60455
Mailing Address - Country:US
Mailing Address - Phone:708-594-6611
Mailing Address - Fax:708-594-0249
Practice Address - Street 1:7235 W. 79TH STREET
Practice Address - Street 2:
Practice Address - City:BRIDGEVIEW
Practice Address - State:IL
Practice Address - Zip Code:60455
Practice Address - Country:US
Practice Address - Phone:708-594-6611
Practice Address - Fax:708-594-0249
Is Sole Proprietor?:No
Enumeration Date:2010-02-22
Last Update Date:2010-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL051-287032183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist