=====================================================
General NPI Number Information
=====================================================
NPI Number | 1700320918
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | RIMA BALSARA
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/06/2016
-----------------------------------------------------
Last Update Date | 12/06/2016
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1210 ROUTE 130 N
-----------------------------------------------------
City | CINNAMINSON
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 08077-3046
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 856-829-9087
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 19 W CLIFF RD
-----------------------------------------------------
City | COLONIA
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 07067-3803
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 732-882-9725
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 183500000X
-----------------------------------------------------
Taxonomy Name | Pharmacist
-----------------------------------------------------
License Number | 28RI03724400
-----------------------------------------------------
License Number State | NJ
-----------------------------------------------------