Provider Demographics
NPI:1275818684
Name:BALZER, JAMES LESLIE (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:JAMES
Middle Name:LESLIE
Last Name:BALZER
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:904 MANDANA CT
Mailing Address - Street 2:
Mailing Address - City:MODESTO
Mailing Address - State:CA
Mailing Address - Zip Code:95358-6700
Mailing Address - Country:US
Mailing Address - Phone:209-568-9893
Mailing Address - Fax:
Practice Address - Street 1:1830 W 11TH ST
Practice Address - Street 2:
Practice Address - City:TRACY
Practice Address - State:CA
Practice Address - Zip Code:95376-3736
Practice Address - Country:US
Practice Address - Phone:209-832-1498
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-10-17
Last Update Date:2011-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CARPH51674183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist