Provider Demographics
NPI:1093719890
Name:BARAMA DRUG OF PAULLINA INC
Entity Type:Organization
Organization Name:BARAMA DRUG OF PAULLINA INC
Other - Org Name:BARAMA DRUG
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PHARMACIST/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:TERRY
Authorized Official - Middle Name:
Authorized Official - Last Name:MORRIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:712-448-3490
Mailing Address - Street 1:127 N MAIN
Mailing Address - Street 2:
Mailing Address - City:PAULLINA
Mailing Address - State:IA
Mailing Address - Zip Code:51046-7758
Mailing Address - Country:US
Mailing Address - Phone:712-448-3490
Mailing Address - Fax:712-448-2338
Practice Address - Street 1:127 N. MAIN
Practice Address - Street 2:
Practice Address - City:PAULLINA
Practice Address - State:IA
Practice Address - Zip Code:51046
Practice Address - Country:US
Practice Address - Phone:712-448-3490
Practice Address - Fax:712-448-2338
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-06-09
Last Update Date:2012-02-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA529333600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0208181Medicaid
IAD08605979Medicare ID - Type Unspecified
IA4650230001Medicare NSC