Healthcare Provider Details

I. General information

NPI: 1942537030
Provider Name (Legal Business Name): BALLANTYNE PHARMACY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/10/2009
Last Update Date: 11/16/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3419 TORINGDON WAY STE A-108
CHARLOTTE NC
28277-2427
US

IV. Provider business mailing address

3419 TORINGDON WAY STE A-108
CHARLOTTE NC
28277-2427
US

V. Phone/Fax

Practice location:
  • Phone: 443-865-3281
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1835P1200X
TaxonomyPharmacotherapy Pharmacist
License Number10384
License Number StateNC

VIII. Authorized Official

Name: DR. PRINCE KWADWO BOAKYE
Title or Position: OWNER (CEO)
Credential: PHARM D
Phone: 443-865-3281