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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
3330 N LINCOLN AVE STE B, CHICAGO, IL 60657-1108
(773) 348-0027
(773) 549-2630
Mailing address
3330 N LINCOLN AVE STE B, CHICAGO, IL 60657-1108
Taxonomy
Speciality
Code
Description
License number
State
333600000X
Pharmacy
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1483142
NCPDP PROVIDER IDENTIFICATION NUMBER
—
Enumeration date
04/07/2009
Last updated
04/07/2009
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