Provider Demographics
NPI:1750971321
Name:BALCHIN, RALPH WALDO JR (PHARMACIST)
Entity type:Individual
Prefix:MR
First Name:RALPH
Middle Name:WALDO
Last Name:BALCHIN
Suffix:JR
Gender:M
Credentials:PHARMACIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:575 GLYNN ST N
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30214-1198
Mailing Address - Country:US
Mailing Address - Phone:770-461-3911
Mailing Address - Fax:770-461-1121
Practice Address - Street 1:575 GLYNN ST N
Practice Address - Street 2:
Practice Address - City:FAYETTEVILLE
Practice Address - State:GA
Practice Address - Zip Code:30214-1198
Practice Address - Country:US
Practice Address - Phone:770-461-3911
Practice Address - Fax:770-461-1121
Is Sole Proprietor?:Yes
Enumeration Date:2021-01-19
Last Update Date:2021-01-19
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
GA009653183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes183500000XPharmacy Service ProvidersPharmacistGroup - Single Specialty