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NPI Code Detail

MEDICARE: BALANCED SOLUTIONS COMPOUNDING PHARMACY, LLC.

MEDICARE: BALANCED SOLUTIONS COMPOUNDING PHARMACY, LLC.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1332B00000XDurable Medical Equipment & Medical Supplies
23336C0004XCompounding Pharmacy
33336C0003XCommunity/Retail PharmacyPH25311FL

General Provider Information

NPI Number : 1467750679
Entity Type Code : Organization
Provider Name (Legal Business Name) : BALANCED SOLUTIONS COMPOUNDING PHARMACY, LLC.
Provider Business Mailing Address
First Line : 550 TECHNOLOGY PARK
Second Line : SUITE 1008
City : LAKE MARY
State : FL
Zip : 32746-7131
Country : US
Telephone Number : 407-936-2999
Fax Number : 800-910-7195
Provider Business Practice Location Address
First Line : 550 TECHNOLOGY PARK
Second Line : SUITE 1008
City : LAKE MARY
State : FL
Zip : 32746-7131
Country : US
Telephone Number : 407-936-2999
Fax Number : 800-910-7195
Authorized Official
Title or Position : BSD GENERAL MANAGER
Name : DR. KEVIN A WILTZ II
Credential : MD
Telephone Number : 407-936-2999
Provider Enumeration Date : 03/11/2011
Last Update Date : 03/11/2011

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