Provider Demographics
NPI:1982764197
Name:BALES PHARMACY, INC.
Entity Type:Organization
Organization Name:BALES PHARMACY, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ROGER
Authorized Official - Middle Name:A
Authorized Official - Last Name:BALES
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:620-584-2025
Mailing Address - Street 1:116 EAST ROSS ST
Mailing Address - Street 2:
Mailing Address - City:CLEARWATER
Mailing Address - State:KS
Mailing Address - Zip Code:67026-0459
Mailing Address - Country:US
Mailing Address - Phone:620-584-2025
Mailing Address - Fax:620-584-5139
Practice Address - Street 1:116 EAST ROSS ST
Practice Address - Street 2:
Practice Address - City:CLEARWATER
Practice Address - State:KS
Practice Address - Zip Code:67026-7821
Practice Address - Country:US
Practice Address - Phone:620-584-2025
Practice Address - Fax:620-584-5139
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-11
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS73993336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy