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Organization
FOND DU LAC RESERVATION BUSINESS COMMITTEE
Active
Organization
FOND DU LAC RESERVATION BUSINESS COMMITTEE
Active
Other names
FOND DU LAC CAIR PHARMACY
Organization subpart
No
Provider details
NPI number
Authorized official
MARILYN GROVER (ASSOCIATE DIRECTOR)
(218) 879-1227
Entity
Organization
Contact information
Practice address
221 W 4TH ST, DULUTH, MN 55806-2719
(218) 279-4142
(218) 279-4077
Mailing address
FOND DU LAC HUMAN SERV DIVISION, 927 TRETTEL LANE, CLOQUET, MN 55720
(218) 829-1227
(218) 878-2188
Taxonomy
Speciality
Code
Description
License number
State
332800000X
Indian Health Service/Tribal/Urban Indian Health (I/T/U) Pharmacy
Primary
260913
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2047381
PK
—
05
—
66815100
—
MN
Enumeration date
01/31/2008
Last updated
07/21/2022
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