Provider Demographics
NPI:1336529262
Name:INGRAM & BALL, PLLC
Entity Type:Organization
Organization Name:INGRAM & BALL, PLLC
Other - Org Name:HEARTLAND PRIMARY CARE PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:GARY
Authorized Official - Middle Name:
Authorized Official - Last Name:GREEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:502-939-6085
Mailing Address - Street 1:3206 WILDWOOD TRL
Mailing Address - Street 2:
Mailing Address - City:LA GRANGE
Mailing Address - State:KY
Mailing Address - Zip Code:40031-8232
Mailing Address - Country:US
Mailing Address - Phone:502-939-6085
Mailing Address - Fax:866-263-2295
Practice Address - Street 1:2412 RING RD STE 200
Practice Address - Street 2:
Practice Address - City:ELIZABETHTOWN
Practice Address - State:KY
Practice Address - Zip Code:42701-5913
Practice Address - Country:US
Practice Address - Phone:270-765-5926
Practice Address - Fax:866-263-2295
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-06-05
Last Update Date:2015-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYP076913336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2152359OtherPK