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Organization
FOND DU LAC RESERVATION BUSINESS COMMITTEE
Active
Organization
FOND DU LAC RESERVATION BUSINESS COMMITTEE
Active
Parent organization
FOND DU LAC HUMAN SERVICES DIVISION
Other names
Mashkiki Waakaaigan Pharmacy
Organization subpart
Yes
Provider details
NPI number
Legal business name
FOND DU LAC HUMAN SERVICES DIVISION
Authorized official
MR. MARILYN GROVER (ASSOCIATE DIRECTOR)
(218) 878-2101
Entity
Organization
Contact information
Practice address
2020 BLOOMINGTON AVE, MINNEAPOLIS, MN 55404-3073
(612) 871-1989
(612) 222-3463
Mailing address
927 TRETTEL LANE, FOND DU LAC HUMAN SERVICES DIVISION, CLOQUET, MN 55720
(218) 879-1227
(218) 878-3755
Taxonomy
Speciality
Code
Description
License number
State
332800000X
Indian Health Service/Tribal/Urban Indian Health (I/T/U) Pharmacy
Primary
263031
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2428349
NCPDP
MN
05
—
666815100
—
MN
Enumeration date
02/01/2008
Last updated
10/12/2017
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