| NPI | 1225441157 |
|---|---|
| Doing Business As | GRAND ITASCA PHARMACY |
| Entity Type | Organization |
| Authorized Contact | JEAN MACDONELL CEO 218-326-3401 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 3336C0003X Pharmacy, Community/Retail Pharmacy |
| Enumeration Date | 2014-06-09 |
| Last Update Date | 2022-03-24 |