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Organization
PHS INDIAN HOSPITAL
Active
Organization
PHS INDIAN HOSPITAL
Active
Other names
RED LAKE INDIAN HOSPITAL PHARMACY
Organization subpart
No
Provider details
NPI number
Authorized official
JAN THUNDER (BUSINESS OFFICE MANAGER)
(218) 679-0148
Entity
Organization
Contact information
Practice address
24670 HOSPITAL DRIVE, RED LAKE, MN 56671
(218) 679-0173
(218) 679-0189
Mailing address
4100 W. 150TH ST, LB: 95419, CLEVELAND, OH 44135
Taxonomy
Speciality
Code
Description
License number
State
332800000X
Indian Health Service/Tribal/Urban Indian Health (I/T/U) Pharmacy
Primary
2604653
MN
332B00000X
Durable Medical Equipment & Medical Supplies
—
—
3336C0002X
Clinic Pharmacy
—
—
3336S0011X
Specialty Pharmacy
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2046533
PK
—
05
—
476753500
—
MN
Enumeration date
02/28/2007
Last updated
01/19/2024
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