Provider Demographics
NPI:1811154974
Name:BALAN, JORDIANNE ORALLO (PHARMD)
Entity type:Individual
Prefix:
First Name:JORDIANNE
Middle Name:ORALLO
Last Name:BALAN
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 1:16029 NW JOSCELYN ST
Mailing Address - Street 2:
Mailing Address - City:BEAVERTON
Mailing Address - State:OR
Mailing Address - Zip Code:97006-7261
Mailing Address - Country:US
Mailing Address - Phone:971-221-6094
Mailing Address - Fax:
Practice Address - Street 1:16029 NW JOSCELYN ST
Practice Address - Street 2:
Practice Address - City:BEAVERTON
Practice Address - State:OR
Practice Address - Zip Code:97006-7261
Practice Address - Country:US
Practice Address - Phone:971-221-6094
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-05-16
Last Update Date:2008-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR11198183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist