Individual
DR. GLENN NAZARETH BALIAN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
R.PH., PHARM.D., MBA
Contact information
Practice address
150 S HUNTINGTON AVE, BOSTON, MA 02130-4817
(857) 364-4309
Mailing address
27 COMMONWEALTH RD, APARTMENT 2, WATERTOWN, MA 02472-1318
(617) 678-3515
Taxonomy
Speciality
Code
Description
License number
State
183500000X
Pharmacist
Primary
PH233397
MA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
PH233397
MASSACHUSETTS PHARMACY LICENSE
MA
Enumeration date
07/05/2011
Last updated
07/05/2011
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