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Organization
BALLIN PHARMACY LTC INC
Active
Organization
BALLIN PHARMACY LTC INC
Active
Other names
BALLIN PHARMACY LTC INC
Organization subpart
No
Provider details
NPI number
Authorized official
WM MATTSON (OWNER RPH)
(773) 348-0027
Entity
Organization
Contact information
Practice address
3327 N PAULINA ST STE 1, CHICAGO, IL 60657-1035
(773) 348-3009
(773) 348-0028
Mailing address
3327 N PAULINA ST STE 1, CHICAGO, IL 60657-1035
(773) 348-3009
(773) 348-0028
Taxonomy
Speciality
Code
Description
License number
State
333600000X
Pharmacy
—
—
3336L0003X
Long Term Care Pharmacy
Primary
054016603
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2119620
PK
—
Enumeration date
03/31/2009
Last updated
03/18/2016
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