Provider Demographics
NPI:1528669413
Name:BALUSEK, LUCY JEANINE
Entity type:Individual
Prefix:
First Name:LUCY
Middle Name:JEANINE
Last Name:BALUSEK
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3621 CASTLE RIVER DR
Mailing Address - Street 2:
Mailing Address - City:CORPUS CHRISTI
Mailing Address - State:TX
Mailing Address - Zip Code:78410-3603
Mailing Address - Country:US
Mailing Address - Phone:361-232-7313
Mailing Address - Fax:
Practice Address - Street 1:3829 INTERSTATE HIGHWAY 69 ACCESS RD
Practice Address - Street 2:
Practice Address - City:CORPUS CHRISTI
Practice Address - State:TX
Practice Address - Zip Code:78410-4525
Practice Address - Country:US
Practice Address - Phone:361-387-4920
Practice Address - Fax:361-387-6773
Is Sole Proprietor?:No
Enumeration Date:2020-11-05
Last Update Date:2020-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX32892183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist