Individual
BALA KODE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
PHARMD
Contact information
Practice address
2306 NORTH BLVD W STE A, DAVENPORT, FL 33837-8976
(863) 547-9922
Mailing address
2306 NORTH BLVD W STE A, DAVENPORT, FL 33837-8976
Taxonomy
Speciality
Code
Description
License number
State
183500000X
Pharmacist
Primary
PS35148
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
PS35148
BOARD OF PHARMACY
FL
Enumeration date
08/28/2020
Last updated
08/28/2020
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