Provider Demographics
NPI:1992308548
Name:BALL, CHADWICK L (PHARMD)
Entity type:Individual
Prefix:DR
First Name:CHADWICK
Middle Name:L
Last Name:BALL
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1008 SE LOUIS DR
Mailing Address - Street 2:
Mailing Address - City:MULVANE
Mailing Address - State:KS
Mailing Address - Zip Code:67110-1109
Mailing Address - Country:US
Mailing Address - Phone:316-777-1601
Mailing Address - Fax:316-777-1693
Practice Address - Street 1:1008 SE LOUIS DR
Practice Address - Street 2:
Practice Address - City:MULVANE
Practice Address - State:KS
Practice Address - Zip Code:67110-1109
Practice Address - Country:US
Practice Address - Phone:316-777-1601
Practice Address - Fax:316-777-1693
Is Sole Proprietor?:Yes
Enumeration Date:2020-11-17
Last Update Date:2020-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS1-13150183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist