Individual
JORDAN BAUTISTA GELACIO
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
620 JOHN PAUL JONES CIR, PORTSMOUTH, VA 23708-2111
(619) 947-3757
Mailing address
620 JOHN PAUL JONES CIR, PORTSMOUTH, VA 23708-2111
Taxonomy
Speciality
Code
Description
License number
State
183500000X
Pharmacist
Primary
90172
CA
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
08/20/2020
Last updated
01/13/2025
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