Provider Demographics
NPI:1497376503
Name:BALL BROTHERS RX, LLC
Entity Type:Organization
Organization Name:BALL BROTHERS RX, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PIC
Authorized Official - Prefix:
Authorized Official - First Name:CHADWICK
Authorized Official - Middle Name:L
Authorized Official - Last Name:BALL
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMD
Authorized Official - Phone:316-777-1601
Mailing Address - Street 1:1008 SE LOUIS DR
Mailing Address - Street 2:
Mailing Address - City:MULVANE
Mailing Address - State:KS
Mailing Address - Zip Code:67110-1109
Mailing Address - Country:US
Mailing Address - Phone:316-777-1601
Mailing Address - Fax:316-777-1693
Practice Address - Street 1:1008 SE LOUIS DR
Practice Address - Street 2:
Practice Address - City:MULVANE
Practice Address - State:KS
Practice Address - Zip Code:67110-1109
Practice Address - Country:US
Practice Address - Phone:316-777-1601
Practice Address - Fax:316-777-1693
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-04-29
Last Update Date:2020-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336L0003XSuppliersPharmacyLong Term Care Pharmacy