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Organization
FOND DU LAC RESERVATION BUSINESS COMMITTEE
Active
Organization
FOND DU LAC RESERVATION BUSINESS COMMITTEE
Active
Other names
MNAW Pharmacy
Organization subpart
No
Provider details
NPI number
Authorized official
MARILYN GROVER (ASSOCIATE DIRECTOR)
(218) 879-1227
Entity
Organization
Contact information
Practice address
927 TRETTEL LN, CLOQUET, MN 55720-1345
(218) 879-1227
(218) 878-2179
Mailing address
927 TRETTEL LN, CLOQUET, MN 55720-1345
(218) 879-1227
(218) 878-2179
Taxonomy
Speciality
Code
Description
License number
State
332800000X
Indian Health Service/Tribal/Urban Indian Health (I/T/U) Pharmacy
Primary
260425
MN
3336C0002X
Clinic Pharmacy
260425
MN
Other
Enumeration date
06/06/2012
Last updated
09/11/2017
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