Provider Demographics
NPI:1386726586
Name:BALLIET, NORMAN (PHARMACIST)
Entity type:Individual
Prefix:
First Name:NORMAN
Middle Name:
Last Name:BALLIET
Suffix:
Gender:M
Credentials:PHARMACIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1414 16TH ST
Mailing Address - Street 2:
Mailing Address - City:CENTRAL CITY
Mailing Address - State:NE
Mailing Address - Zip Code:68826-1812
Mailing Address - Country:US
Mailing Address - Phone:308-946-3859
Mailing Address - Fax:308-946-3850
Practice Address - Street 1:1414 16TH ST
Practice Address - Street 2:
Practice Address - City:CENTRAL CITY
Practice Address - State:NE
Practice Address - Zip Code:68826-1812
Practice Address - Country:US
Practice Address - Phone:308-946-3859
Practice Address - Fax:308-946-3850
Is Sole Proprietor?:No
Enumeration Date:2006-10-19
Last Update Date:2020-12-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE8204183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE47075580501Medicaid
0279270001Medicare ID - Type Unspecified