Provider Demographics
NPI:1720381940
Name:BAKALL LOWGREN, MAJA (RPH)
Entity Type:Individual
Prefix:
First Name:MAJA
Middle Name:
Last Name:BAKALL LOWGREN
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1686 E FLORENCE BLVD
Mailing Address - Street 2:
Mailing Address - City:CASA GRANDE
Mailing Address - State:AZ
Mailing Address - Zip Code:85122-4777
Mailing Address - Country:US
Mailing Address - Phone:520-836-4357
Mailing Address - Fax:
Practice Address - Street 1:1686 E FLORENCE BLVD
Practice Address - Street 2:
Practice Address - City:CASA GRANDE
Practice Address - State:AZ
Practice Address - Zip Code:85122-4777
Practice Address - Country:US
Practice Address - Phone:520-836-4357
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-12-09
Last Update Date:2014-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZS017728183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZS017728Other183500000X-PHARMACIST