Provider Demographics
NPI:1063690519
Name:BALEN, CONNIE CHI (RPH)
Entity type:Individual
Prefix:MRS
First Name:CONNIE
Middle Name:CHI
Last Name:BALEN
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15079 LEVITA CT
Mailing Address - Street 2:
Mailing Address - City:POWAY
Mailing Address - State:CA
Mailing Address - Zip Code:92064-2432
Mailing Address - Country:US
Mailing Address - Phone:858-748-7804
Mailing Address - Fax:
Practice Address - Street 1:11939 RANCHO BERNARDO RD
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92128-2073
Practice Address - Country:US
Practice Address - Phone:858-674-2365
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-02-07
Last Update Date:2008-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA45999183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist