# FOSSTON LONG TERM CARE PHARMACY, INC

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Nord's Long Term Care Pharmacy
- **Organization subpart:** No

## Provider details

- **NPI number:** 1558704502
- **Authorized official:** RUTH FONDER PHARM D (PRESIDENT)
- **Authorized official phone:** (218) 435-6646

## Contact information

- **Practice address:** 115 JOHNSON AVE N STE A, FOSSTON, MN 56542-1327
- **Practice address phone:** (218) 435-6646
- **Practice address fax:** (218) 435-1564
- **Mailing address:** 115 JOHNSON AVE N STE A, FOSSTON, MN 56542-1327
- **Mailing address phone:** (218) 435-6646
- **Mailing address fax:** (218) 435-1564

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 3336L0003X | Long Term Care Pharmacy | 264082 | MN | Yes |

## Other

- **Enumeration date:** 04/09/2013
- **Last updated:** 01/20/2017

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 1558704502 | — | MN |