NPIMap

Organization Active NPI

Ballentine Pharmacy Inc

  • Pharmacy
  • Deckerville, MI
National Provider Identifier
1366440612
Registry record updated Aug 22, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
PharmacyTaxonomy code 333600000X
License
5301000086 Issued in MI
Legal business name
BALLENTINE PHARMACY INC
Practice address
3482 Main St
Deckerville, MI 48427-9633
Phone
(810) 376-2825
Fax
(810) 376-8355
NPI assigned
Jul 11, 2005
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 22, 2020

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Joan BallentineNPI 1841368362
Title
Owner
Phone
(810) 376-2825

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Pharmacy 333600000X 5301000086 MI Primary

Addresses

Primary practice location

3482 Main St
Deckerville, MI 48427-9633

Mailing address

3482 Main St
PO Box 67
Deckerville, MI 48427-9633

Other identifiers 1

IdentifierTypeStateIssuer
2313536MedicaidMI

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1121040000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1366440612",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3482 MAIN ST",
            "address_2": "PO BOX 67",
            "city": "DECKERVILLE",
            "state": "MI",
            "postal_code": "484279633"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3482 MAIN ST",
            "city": "DECKERVILLE",
            "state": "MI",
            "postal_code": "484279633",
            "telephone_number": "810-376-2825",
            "fax_number": "810-376-8355"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BALLENTINE PHARMACY INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-07-11",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "BALLENTINE",
        "authorized_official_first_name": "JOAN",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "810-376-2825"
    },
    "taxonomies": [
        {
            "code": "333600000X",
            "taxonomy_group": "",
            "desc": "Pharmacy",
            "state": "MI",
            "license": "5301000086",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "2313536",
            "state": "MI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Deckerville, MI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.