Healthcare Provider Details

I. General information

NPI: 1720435035
Provider Name (Legal Business Name): AMANA SOCIETY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/17/2016
Last Update Date: 07/27/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1100 TALL GRASS AVE
TIFFIN IA
52340-4753
US

IV. Provider business mailing address

PO BOX 189
AMANA IA
52203-0189
US

V. Phone/Fax

Practice location:
  • Phone: 319-545-3120
  • Fax: 319-545-3127
Mailing address:
  • Phone: 319-560-0308
  • Fax: 319-622-3090

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number1572
License Number StateIA

VIII. Authorized Official

Name: JEFF POPENHAGEN
Title or Position: DIRECTOR OF MARKETING AND RETAIL
Credential:
Phone: 319-560-0308