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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