Provider Demographics
NPI:1942537030
Name:BALLANTYNE PHARMACY LLC
Entity Type:Organization
Organization Name:BALLANTYNE PHARMACY LLC
Other - Org Name:UNION PHARMACY
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:OWNER (CEO)
Authorized Official - Prefix:DR
Authorized Official - First Name:PRINCE
Authorized Official - Middle Name:KWADWO
Authorized Official - Last Name:BOAKYE
Authorized Official - Suffix:
Authorized Official - Credentials:PHARM D
Authorized Official - Phone:443-865-3281
Mailing Address - Street 1:3419 TORINGDON WAY STE A-108
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28277-2427
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:3419 TORINGDON WAY STE A-108
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28277-2427
Practice Address - Country:US
Practice Address - Phone:443-865-3281
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-11-10
Last Update Date:2010-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC103841835P1200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1835P1200XPharmacy Service ProvidersPharmacistPharmacotherapyGroup - Single Specialty