Healthcare Provider Details

I. General information

NPI: 1336471663
Provider Name (Legal Business Name): BANA MEDICAL SUPPLIES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/11/2010
Last Update Date: 02/11/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6517 76TH AVE N
BROOKLYN PARK MN
55428-1433
US

IV. Provider business mailing address

6517 76TH AVE N
BROOKLYN PARK MN
55428-1433
US

V. Phone/Fax

Practice location:
  • Phone: 763-742-8460
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number370357722
License Number StateMN

VIII. Authorized Official

Name: XUAN LY
Title or Position: OWNER
Credential:
Phone: 763-742-8460