Provider Demographics
NPI:1942516398
Name:BALELLA, JERRY GREGORY JR (RPH)
Entity Type:Individual
Prefix:MR
First Name:JERRY
Middle Name:GREGORY
Last Name:BALELLA
Suffix:JR
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4537 NEW FALLS RD
Mailing Address - Street 2:
Mailing Address - City:LEVITTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:19056
Mailing Address - Country:US
Mailing Address - Phone:215-945-0961
Mailing Address - Fax:215-945-4978
Practice Address - Street 1:4537 NEW FALLS RD
Practice Address - Street 2:
Practice Address - City:LEVITTOWN
Practice Address - State:PA
Practice Address - Zip Code:19056
Practice Address - Country:US
Practice Address - Phone:215-945-0961
Practice Address - Fax:215-945-4978
Is Sole Proprietor?:Yes
Enumeration Date:2010-08-24
Last Update Date:2010-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARP035744R1835P0018X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P0018XPharmacy Service ProvidersPharmacistPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1366532483OtherNPI NUMBER