Provider Demographics
NPI:1093293532
Name:BAHAM PHARMACY & WELLNESS LLC
Entity Type:Organization
Organization Name:BAHAM PHARMACY & WELLNESS LLC
Other - Org Name:BAHAM PHARMACY AND WELLNESS
Other - Org Type:Other Name
Authorized Official - Title/Position:OWNER/ PHARMACIST
Authorized Official - Prefix:
Authorized Official - First Name:MEGAN
Authorized Official - Middle Name:
Authorized Official - Last Name:BAHAM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:985-273-5099
Mailing Address - Street 1:28215 BIG SKY LN
Mailing Address - Street 2:
Mailing Address - City:FOLSOM
Mailing Address - State:LA
Mailing Address - Zip Code:70437-7689
Mailing Address - Country:US
Mailing Address - Phone:504-237-7432
Mailing Address - Fax:
Practice Address - Street 1:3916 HIGHWAY 22
Practice Address - Street 2:
Practice Address - City:MANDEVILLE
Practice Address - State:LA
Practice Address - Zip Code:70471-7306
Practice Address - Country:US
Practice Address - Phone:985-273-5099
Practice Address - Fax:985-206-9766
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-08-06
Last Update Date:2018-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy