Healthcare Provider Details

I. General information

NPI: 1710998224
Provider Name (Legal Business Name): BAMA INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/10/2006
Last Update Date: 08/31/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1214 ATLANTIC AVE
BENSON MN
56215-1243
US

IV. Provider business mailing address

1214 ATLANTIC AVE
BENSON MN
56215-1243
US

V. Phone/Fax

Practice location:
  • Phone: 320-842-3221
  • Fax: 320-843-9974
Mailing address:
  • Phone: 320-842-3221
  • Fax: 320-843-9974

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 Number205959
License Number StateMN

VIII. Authorized Official

Name: BARRY JUNGWIRTH
Title or Position: OWNER
Credential:
Phone: 320-842-3221