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General NPI Number Information
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NPI Number | 1205978996
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Entity Type | Organization
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Legal Business Name | BINGAMITE
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Dates
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Enumeration Date | 02/12/2007
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Last Update Date | 12/10/2008
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Provider Practice Location Address
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Address Line | 113 N 2ND AVE W
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City | DULUTH
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State | MN
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Zip | 55802-1911
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Country | US
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Telephone | 218-722-3977
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Fax | 218-726-9087
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Provider Business Mailing Address
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Address Line | 113 N 2ND AVE W
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City | DULUTH
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State | MN
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Zip | 55802-1911
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Country | US
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Telephone | 218-722-3977
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Fax | 218-726-9087
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Authorized Official
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Title or Position | CEO
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Name | CHARLES KORSCH
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Credential | RPH
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Telephone | 218-722-3977
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 3336C0003X
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Taxonomy Name | Community/Retail Pharmacy
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License Number | 200610-9
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License Number State | MN
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