| NPI | 1346383908 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | LINDA M DESROSIER Manager 218-463-2465 |
| Organization Subpart ? | No |
| Primary Taxonomy | 3336C0003X Pharmacy, Community/Retail Pharmacy (Licence: MN 201190) |
| Additional Taxonomies | 3336L0003X Pharmacy, Long Term Care Pharmacy (Licence: MN 201190) |
| 3336C0004X Pharmacy, Compounding Pharmacy (Licence: MN 201190) | |
| 332B00000X Durable Medical Equipment & Medical Supplies (Licence: MN 0683560001) | |
| Enumeration Date | 2007-02-14 |
| Last Update Date | 2023-03-07 |