| NPI | 1144809369 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | CHARLENE ANDERSEN Revenue Generating Supervisor 218-679-1320 |
| Organization Subpart ? | No |
| Primary Taxonomy | 332800000X Indian Health Service/Tribal/Urban Indian Health (I/T/U) Pharmacy |
| Enumeration Date | 2021-04-05 |
| Last Update Date | 2022-01-03 |