Organization
BAMA INC
Active
Other names
CLARKS REXALL DRUG INC
Organization subpart
No
Provider details
NPI number
Authorized official
BARRY JUNGWIRTH (OWNER)
(320) 842-3221
Entity
Organization
Contact information
Practice address
1214 ATLANTIC AVE, BENSON, MN 56215-1243
(320) 842-3221
(320) 843-9974
Mailing address
1214 ATLANTIC AVE, BENSON, MN 56215-1243
(320) 842-3221
(320) 843-9974
Taxonomy
Speciality
Code
Description
License number
State
333600000X
Pharmacy
—
—
3336C0003X
Community/Retail Pharmacy
Primary
205959
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2403614
NCPDP PROVIDER IDENTIFICATION NUMBER
—
05
—
MN142757100
—
MN
Enumeration date
08/10/2006
Last updated
08/31/2010
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