Provider Demographics
NPI:1003861527
Name:ONAMIA PHARMACY LLC
Entity Type:Organization
Organization Name:ONAMIA PHARMACY LLC
Other - Org Name:ONAMIA DRUG
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:DANA
Authorized Official - Middle Name:MAY
Authorized Official - Last Name:YANG
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMD
Authorized Official - Phone:320-532-3633
Mailing Address - Street 1:516 MAIN STREET
Mailing Address - Street 2:PO BOX 249
Mailing Address - City:ONAMIA
Mailing Address - State:MN
Mailing Address - Zip Code:56359-0249
Mailing Address - Country:US
Mailing Address - Phone:320-532-3633
Mailing Address - Fax:320-532-4442
Practice Address - Street 1:516 MAIN STREET
Practice Address - Street 2:
Practice Address - City:ONAMIA
Practice Address - State:MN
Practice Address - Zip Code:56359-0249
Practice Address - Country:US
Practice Address - Phone:320-532-3633
Practice Address - Fax:320-532-4442
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-23
Last Update Date:2020-11-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN2613110183500000X, 3336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No183500000XPharmacy Service ProvidersPharmacistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
411816216OtherFEDERAL
MN588557400Medicaid
MN588557400Medicaid