Individual
MR. GARY M BALO
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
RPH
Contact information
Practice address
4246 NE SANDY BLVD, PORTLAND, OR 97213-1432
(503) 287-1163
(503) 282-2281
Mailing address
4246 NE SANDY BLVD, PORTLAND, OR 97213-1432
(503) 287-1163
(503) 282-2281
Taxonomy
Speciality
Code
Description
License number
State
183500000X
Pharmacist
Primary
5480
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
5480
STATE LISCENSE
OR
Enumeration date
03/13/2007
Last updated
07/08/2007
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