MEDICARE: DR. JAMES LESLIE BALZER 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	RPH51674	CA

General Provider Information

NPI Number	:	1275818684
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JAMES LESLIE BALZER PHARMD

Provider Business Mailing Address
First Line	:	904 MANDANA CT
Second Line	:
City	:	MODESTO
State	:	CA
Zip	:	95358-6700
Country	:	US
Telephone Number	:	209-568-9893
Fax Number	:

Provider Business Practice Location Address
First Line	:	1830 W 11TH ST
Second Line	:
City	:	TRACY
State	:	CA
Zip	:	95376-3736
Country	:	US
Telephone Number	:	209-832-1498
Fax Number	:

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

Provider Enumeration Date	:	10/17/2011
Last Update Date	:	10/17/2011

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