# ALTRU HEALTH SYSTEM

> Is this information incorrect? This page shows public data from NPPES. Update your record in NPPES and this page will update automatically within 7 days. [Update your NPPES record](https://nppes.cms.hhs.gov)

- **Entity:** Organization
- **Status:** Active
- **Other names:** FAMILY MEDICINE RESIDENCY PHARMACY
- **Organization subpart:** No

## Provider details

- **NPI number:** 1144368085
- **Authorized official:** DEREK GOEBEL (CHIEF FINANCIAL OFFICER)
- **Authorized official phone:** (701) 780-1470

## Contact information

- **Practice address:** 725 HAMLINE ST, GRAND FORKS, ND 58203-2819
- **Practice address phone:** (701) 780-6870
- **Practice address fax:** (701) 780-6878
- **Mailing address:** 725 HAMLINE ST, GRAND FORKS, ND 58203-2819
- **Mailing address phone:** (701) 780-6870
- **Mailing address fax:** (701) 780-6878

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 333600000X | Pharmacy | — | NULL | — |
| 3336C0002X | Clinic Pharmacy | PHAR477 | ND | Yes |

## Other

- **Enumeration date:** 02/02/2007
- **Last updated:** 05/23/2024

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 01 | — | 2071404 | PK | — |
| 05 | — | 21082 | — | ND |
| 05 | — | 574155600 | — | MN |