Organization
BALLENTINE PHARMACY INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JOAN BALLENTINE (OWNER)
(810) 376-2825
Entity
Organization
Contact information
Practice address
3482 MAIN ST, DECKERVILLE, MI 48427-9633
(810) 376-2825
(810) 376-8355
Mailing address
3482 MAIN ST, PO BOX 67, DECKERVILLE, MI 48427-9633
Taxonomy
Speciality
Code
Description
License number
State
333600000X
Pharmacy
Primary
5301000086
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
2313536
—
MI
Enumeration date
07/11/2005
Last updated
08/22/2020
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