Healthcare Provider Details

I. General information

NPI: 1538262696
Provider Name (Legal Business Name): DR MAMAE INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/06/2006
Last Update Date: 03/21/2022
Certification Date: 03/21/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

214 5TH ST
KALONA IA
52247
US

IV. Provider business mailing address

PO BOX 337
KALONA IA
52247-0337
US

V. Phone/Fax

Practice location:
  • Phone: 319-656-3134
  • Fax: 319-656-3165
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number273
License Number StateIA

VIII. Authorized Official

Name: DAVID MCDANEL
Title or Position: VP
Credential:
Phone: 319-656-3134