Provider Demographics
NPI:1265991947
Name:BALLS REXALL DRUGS
Entity type:Organization
Organization Name:BALLS REXALL DRUGS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:KENNETH
Authorized Official - Middle Name:
Authorized Official - Last Name:HEIMANN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:352-726-1021
Mailing Address - Street 1:214 U.S. HWY 41 SOUTH
Mailing Address - Street 2:
Mailing Address - City:INVERNESS
Mailing Address - State:FL
Mailing Address - Zip Code:34450
Mailing Address - Country:US
Mailing Address - Phone:352-726-1021
Mailing Address - Fax:352-726-0164
Practice Address - Street 1:102 E HIGHLAND BLVD
Practice Address - Street 2:
Practice Address - City:INVERNESS
Practice Address - State:FL
Practice Address - Zip Code:34452-4847
Practice Address - Country:US
Practice Address - Phone:352-726-1021
Practice Address - Fax:352-726-4688
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:BALLS REXALL DRUGS
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2019-03-13
Last Update Date:2020-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336L0003XSuppliersPharmacyLong Term Care Pharmacy
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No3336C0004XSuppliersPharmacyCompounding Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL018484200Medicaid
FL0524400001OtherMEDICARE