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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