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NPI Code Detail

MEDICARE: BALLWEG FAMILY PHARMACY INC

MEDICARE: BALLWEG FAMILY PHARMACY INC
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
1333600000XPharmacy
23336C0003XCommunity/Retail Pharmacy8489-42WI

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
12110297OTHERPK

General Provider Information

NPI Number : 1710916416
Entity Type Code : Organization
Provider Name (Legal Business Name) : BALLWEG FAMILY PHARMACY INC
Provider Business Mailing Address
First Line : 1200 PRAIRIE ST
Second Line :
City : PRAIRIE DU SAC
State : WI
Zip : 53578-2041
Country : US
Telephone Number : 608-643-6500
Fax Number :
Provider Business Practice Location Address
First Line : 1200 PRAIRIE ST
Second Line :
City : PRAIRIE DU SAC
State : WI
Zip : 53578-2041
Country : US
Telephone Number : 608-643-6500
Fax Number : 608-643-6533
Authorized Official
Title or Position : OWNER AND PHARMACIST
Name : DENNIS BALLWEG
Credential : RPH
Telephone Number : 608-643-6500
Provider Enumeration Date : 07/03/2006
Last Update Date : 10/06/2023

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Directions to “BALLWEG FAMILY PHARMACY INC ” Practice Location

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