Provider Demographics
NPI:1336652429
Name:BALIBAY, GAVRIELLE CONCEPCION (PHARMD)
Entity Type:Individual
Prefix:
First Name:GAVRIELLE
Middle Name:CONCEPCION
Last Name:BALIBAY
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1820 PLAN TREE DR
Mailing Address - Street 2:
Mailing Address - City:UPLAND
Mailing Address - State:CA
Mailing Address - Zip Code:91784-2523
Mailing Address - Country:US
Mailing Address - Phone:909-653-8418
Mailing Address - Fax:
Practice Address - Street 1:27951 BASELINE ST
Practice Address - Street 2:
Practice Address - City:HIGHLAND
Practice Address - State:CA
Practice Address - Zip Code:92346-3346
Practice Address - Country:US
Practice Address - Phone:909-864-5701
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-11-10
Last Update Date:2022-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA77159183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist