| NPI | 1346501392 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MARILYN GROVER Associate Director 218-879-1227 |
| Organization Subpart ? | No |
| Primary Taxonomy | 332800000X Indian Health Service/Tribal/Urban Indian Health (I/T/U) Pharmacy (Licence: MN 260425) |
| Additional Taxonomies | 3336C0002X Pharmacy Clinic Pharmacy (Licence: MN 260425) |
| Enumeration Date | 2012-06-06 |
| Last Update Date | 2017-09-11 |