# BALLWEG FAMILY PHARMACY INC

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- **Entity:** Organization
- **Status:** Active
- **Parent organization:** BALLWEG FAMILY PHARMACY, INC
- **Other names:** BALLWEG FAMILY PHARMACY INC Long-Term Care
- **Organization subpart:** Yes

## Provider details

- **NPI number:** 1104532654
- **Legal business name:** BALLWEG FAMILY PHARMACY, INC
- **Authorized official:** DENNIS JOHN BALLWEG (PRESIDENT)
- **Authorized official phone:** (608) 643-6500

## Contact information

- **Practice address:** 1200 PRAIRIE ST, PRAIRIE DU SAC, WI 53578-2041
- **Practice address phone:** (608) 643-6500
- **Mailing address:** 1200 PRAIRIE ST, PRAIRIE DU SAC, WI 53578-2041
- **Mailing address phone:** (608) 370-2396

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 3336L0003X | Long Term Care Pharmacy | — | NULL | Yes |

## Other

- **Enumeration date:** 01/27/2023
- **Last updated:** 10/06/2023

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 33282600 | — | WI |