Provider Demographics
NPI:1467750679
Name:BALANCED SOLUTIONS COMPOUNDING PHARMACY, LLC.
Entity Type:Organization
Organization Name:BALANCED SOLUTIONS COMPOUNDING PHARMACY, LLC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BSD GENERAL MANAGER
Authorized Official - Prefix:DR
Authorized Official - First Name:KEVIN
Authorized Official - Middle Name:A
Authorized Official - Last Name:WILTZ
Authorized Official - Suffix:II
Authorized Official - Credentials:MD
Authorized Official - Phone:407-936-2999
Mailing Address - Street 1:550 TECHNOLOGY PARK
Mailing Address - Street 2:SUITE 1008
Mailing Address - City:LAKE MARY
Mailing Address - State:FL
Mailing Address - Zip Code:32746-7131
Mailing Address - Country:US
Mailing Address - Phone:407-936-2999
Mailing Address - Fax:800-910-7195
Practice Address - Street 1:550 TECHNOLOGY PARK
Practice Address - Street 2:SUITE 1008
Practice Address - City:LAKE MARY
Practice Address - State:FL
Practice Address - Zip Code:32746-7131
Practice Address - Country:US
Practice Address - Phone:407-936-2999
Practice Address - Fax:800-910-7195
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-03-11
Last Update Date:2011-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
332B00000X, 3336C0004X
FLPH253113336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No3336C0004XSuppliersPharmacyCompounding Pharmacy