Ashlyn McKenzie Balthazar
Individual provider Active NPI Pharmacist · Vinton, LA
NPI 1255002010 · NPPES record last updated Oct 14, 2023
Key facts
- NPI
- 1255002010
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Pharmacist 183500000X
- License
- 024813 (LA)
- Practice address
- 1301 Horridge St
Vinton, LA 70668-4531 - Phone
- (337) 324-7017
- NPI assigned
- Sep 22, 2021
- Sex
- Female
- Sole proprietor
- No
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 024813 | LA | MD | Pharmacist |
| 69341 | TX | MD | Pharmacist |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pharmacist | 183500000X | 69341 | TX | |
| Pharmacist | 183500000X | 024813 | LA | Yes |
Addresses
Primary practice location
1301 Horridge St
Vinton, LA 70668-4531
Mailing address
1301 Horridge St
Vinton, LA 70668-4531
Other providers in Vinton, LA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Oct 14, 2023. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.