| NPI | 1902379159 |
|---|---|
| Doing Business As | GRAND ITASCA PHARMACY |
| Entity Type | Organization |
| Authorized Contact | JEAN MACDONELL VP, Clinic Services 218-999-1510 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 333600000X Pharmacy |
| Enumeration Date | 2019-01-09 |
| Last Update Date | 2019-01-09 |