Provider Demographics
NPI:1760855027
Name:BALLI, JAIME EDWARDO (PHARM D)
Entity Type:Individual
Prefix:
First Name:JAIME
Middle Name:EDWARDO
Last Name:BALLI
Suffix:
Gender:M
Credentials:PHARM D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:901 S 10TH ST
Mailing Address - Street 2:BLDG 100
Mailing Address - City:MCALLEN
Mailing Address - State:TX
Mailing Address - Zip Code:78501-5061
Mailing Address - Country:US
Mailing Address - Phone:956-683-0091
Mailing Address - Fax:
Practice Address - Street 1:901 S 10TH ST
Practice Address - Street 2:BLDG 100
Practice Address - City:MCALLEN
Practice Address - State:TX
Practice Address - Zip Code:78501-5061
Practice Address - Country:US
Practice Address - Phone:956-683-0091
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-11-09
Last Update Date:2015-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX45493183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist