Provider Demographics
NPI:1720435035
Name:AMANA SOCIETY
Entity Type:Organization
Organization Name:AMANA SOCIETY
Other - Org Name:TIFFIN PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR OF MARKETING AND RETAIL
Authorized Official - Prefix:
Authorized Official - First Name:JEFF
Authorized Official - Middle Name:
Authorized Official - Last Name:POPENHAGEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:319-560-0308
Mailing Address - Street 1:PO BOX 189
Mailing Address - Street 2:
Mailing Address - City:AMANA
Mailing Address - State:IA
Mailing Address - Zip Code:52203-0189
Mailing Address - Country:US
Mailing Address - Phone:319-560-0308
Mailing Address - Fax:319-622-3090
Practice Address - Street 1:1100 TALL GRASS AVE
Practice Address - Street 2:
Practice Address - City:TIFFIN
Practice Address - State:IA
Practice Address - Zip Code:52340-4753
Practice Address - Country:US
Practice Address - Phone:319-545-3120
Practice Address - Fax:319-545-3127
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-05-17
Last Update Date:2016-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
IA15723336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2159967OtherPK
IA1720435035Medicaid