Individual
MR. DOUGLAS ALAN BALOG
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
BS PHARMACY
Contact information
Practice address
292 CHANDELEUR DR, MOORESVILLE, NC 28117-4600
(704) 660-1640
Mailing address
292 CHANDELEUR DR, MOORESVILLE, NC 28117-4600
(704) 660-1640
Taxonomy
Speciality
Code
Description
License number
State
183500000X
Pharmacist
Primary
12965
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
12965
STATE LICENSE
NC
Enumeration date
12/14/2006
Last updated
07/08/2007
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