MEDICARE: DR. RYAN BALANGUE DE JESUS 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	51824	CA

General Provider Information

NPI Number	:	1467082693
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. RYAN BALANGUE DE JESUS PHARMD

Provider Business Mailing Address
First Line	:	2456 S GROVE AVE
Second Line	:
City	:	ONTARIO
State	:	CA
Zip	:	91761-6224
Country	:	US
Telephone Number	:	909-947-9390
Fax Number	:	909-923-3338

Provider Business Practice Location Address
First Line	:	2456 S GROVE AVE
Second Line	:
City	:	ONTARIO
State	:	CA
Zip	:	91761-6224
Country	:	US
Telephone Number	:	909-947-9390
Fax Number	:	909-923-3338

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

Provider Enumeration Date	:	01/15/2020
Last Update Date	:	01/15/2020

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