Provider Demographics
NPI:1902124977
Name:BALLA, KRISTINE E (RPH)
Entity Type:Individual
Prefix:
First Name:KRISTINE
Middle Name:E
Last Name:BALLA
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 1:1130 PERRY HWY
Mailing Address - Street 2:STE 35
Mailing Address - City:PITTSBURGH
Mailing Address - State:PA
Mailing Address - Zip Code:15237-2142
Mailing Address - Country:US
Mailing Address - Phone:412-369-4267
Mailing Address - Fax:412-369-8041
Practice Address - Street 1:1130 PERRY HWY
Practice Address - Street 2:STE 35
Practice Address - City:PITTSBURGH
Practice Address - State:PA
Practice Address - Zip Code:15237-2142
Practice Address - Country:US
Practice Address - Phone:412-369-4267
Practice Address - Fax:412-369-8041
Is Sole Proprietor?:Yes
Enumeration Date:2010-05-14
Last Update Date:2010-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARP040086L183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PARP040086LOtherPA STATE LICENSE NUMBER