MEDICARE: MR. JAMES BALLACCHINO RPH

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	30082	NY

General Provider Information

NPI Number	:	1255516894
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. JAMES BALLACCHINO RPH

Provider Business Mailing Address
First Line	:	476 WILLIAM ST
Second Line	:
City	:	BUFFALO
State	:	NY
Zip	:	14206-1538
Country	:	US
Telephone Number	:	716-847-0424
Fax Number	:

Provider Business Practice Location Address
First Line	:	476 WILLIAM ST
Second Line	:
City	:	BUFFALO
State	:	NY
Zip	:	14206-1538
Country	:	US
Telephone Number	:	716-847-0424
Fax Number	:

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

Provider Enumeration Date	:	01/02/2008
Last Update Date	:	01/02/2008

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Directions to “ MR. JAMES BALLACCHINO RPH” Practice Location

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