MEDICARE: JESSICA JOY BALAORO PHARMD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	183500000X	Pharmacist	067727	NY

General Provider Information

NPI Number	:	1114627841
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JESSICA JOY BALAORO PHARMD

Provider Business Mailing Address
First Line	:	2529 44TH DR
Second Line	:
City	:	LONG ISLAND CITY
State	:	NY
Zip	:	11101-4202
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2529 44TH DR
Second Line	:
City	:	LONG ISLAND CITY
State	:	NY
Zip	:	11101-4202
Country	:	US
Telephone Number	:	718-736-2200
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/10/2023
Last Update Date	:	03/10/2023

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