Organization
POWELL'S PRECIOUS LOTUS LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
KIM POWELL (OWNER/PRESIDENT)
(574) 387-9160
Entity
Organization
Contact information
Practice address
5316 REO AVE, SOUTH BEND, IN 46619-1341
(574) 440-1731
Mailing address
5316 REO AVE, SOUTH BEND, IN 46619-1341
(574) 387-9160
Taxonomy
Speciality
Code
Description
License number
State
253Z00000X
In Home Supportive Care Agency
Primary
—
—
332800000X
Indian Health Service/Tribal/Urban Indian Health (I/T/U) Pharmacy
—
—
Other
Enumeration date
11/22/2023
Last updated
09/24/2024
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