Provider Demographics
NPI:1174625818
Name:BALLESTEROS, DAVID AMPARO JR (PHARMD)
Entity type:Individual
Prefix:DR
First Name:DAVID
Middle Name:AMPARO
Last Name:BALLESTEROS
Suffix:JR
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:526 DRUID HILLS RD
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33617-3862
Mailing Address - Country:US
Mailing Address - Phone:813-767-5698
Mailing Address - Fax:
Practice Address - Street 1:11701 BELCHER RD S
Practice Address - Street 2:SUITE 128
Practice Address - City:LARGO
Practice Address - State:FL
Practice Address - Zip Code:33773-5135
Practice Address - Country:US
Practice Address - Phone:727-523-2530
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-09-02
Last Update Date:2013-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS34719183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist