MEDICARE: DR. JENNIFER DENISE BALOUN PHARM.D.

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	26691	TN
2	183500000X	Pharmacist	RPH018246	GA

General Provider Information

NPI Number	:	1770744179
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JENNIFER DENISE BALOUN PHARM.D.

Provider Business Mailing Address
First Line	:	480 HIGHWAY 76
Second Line	:
City	:	WHITE HOUSE
State	:	TN
Zip	:	37188-9201
Country	:	US
Telephone Number	:	615-672-4930
Fax Number	:	615-672-6961

Provider Business Practice Location Address
First Line	:	480 HIGHWAY 76
Second Line	:
City	:	WHITE HOUSE
State	:	TN
Zip	:	37188-9201
Country	:	US
Telephone Number	:	615-672-4930
Fax Number	:	615-672-6961

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

Provider Enumeration Date	:	06/19/2008
Last Update Date	:	06/19/2008

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