Provider Demographics
NPI:1487259347
Name:BALOLA, MARIUS IBUYE (PHARMD, RPH)
Entity type:Individual
Prefix:
First Name:MARIUS
Middle Name:IBUYE
Last Name:BALOLA
Suffix:
Gender:M
Credentials:PHARMD, RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:214 VIKING PLAZA DR
Mailing Address - Street 2:
Mailing Address - City:CEDAR FALLS
Mailing Address - State:IA
Mailing Address - Zip Code:50613-6936
Mailing Address - Country:US
Mailing Address - Phone:319-553-1121
Mailing Address - Fax:
Practice Address - Street 1:214 VIKING PLAZA DR
Practice Address - Street 2:
Practice Address - City:CEDAR FALLS
Practice Address - State:IA
Practice Address - Zip Code:50613-6936
Practice Address - Country:US
Practice Address - Phone:319-553-1121
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-11-30
Last Update Date:2020-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA23801183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist