Active NPI
Mark Ballesteros, PHARM.D.
- Pharmacist
- Peterson AFB, CO
National Provider Identifier
1245277888
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pharmacist
- License
- 12859
- Practice address
- 559 Vincent St
Peterson AFB, CO 80914-1541 - Phone
- (719) 556-1108
- NPI assigned
- Jun 1, 2006
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pharmacist | 183500000X | 12859 | AZ | Primary |
Addresses
Primary practice location
559 Vincent St
Peterson AFB, CO 80914-1541
Mailing address
559 Vincent St
Peterson AFB, CO 80914-1541
Phone (719) 556-1108
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Doctor of Pharmacy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 12859 | AZ | MD | Pharmacist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1149120000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1616457600000",
"number": "1245277888",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "559 VINCENT ST",
"city": "PETERSON AFB",
"state": "CO",
"postal_code": "809141541",
"telephone_number": "719-556-1108"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "559 VINCENT ST",
"city": "PETERSON AFB",
"state": "CO",
"postal_code": "809141541",
"telephone_number": "719-556-1108"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BALLESTEROS",
"first_name": "MARK",
"name_prefix": "Dr.",
"credential": "PHARM.D.",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-06-01",
"last_updated": "2021-03-23",
"certification_date": "2021-03-23",
"status": "A"
},
"taxonomies": [
{
"code": "183500000X",
"taxonomy_group": "",
"desc": "Pharmacist",
"state": "AZ",
"license": "12859",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Peterson AFB, CO
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 23, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.