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Organization
LAC VIEUX DESERT BAND OF LAKE SUPERIOR CHIPPEWA INDIANS
Active
Organization
LAC VIEUX DESERT BAND OF LAKE SUPERIOR CHIPPEWA INDIANS
Active
Other names
Lac Vieux Desert Health Center and Pharmacy
Organization subpart
No
Provider details
NPI number
Authorized official
SADIE VALLIERE (HEALTH DIRECTOR)
(906) 358-4587
Entity
Organization
Contact information
Practice address
N5241 US HIGHWAY 45, WATERSMEET, MI 49969-5115
(906) 358-4905
(906) 358-4929
Mailing address
N5241 US HIGHWAY 45, WATERSMEET, MI 49969-5115
(906) 358-4905
(906) 358-4929
Taxonomy
Speciality
Code
Description
License number
State
332800000X
Indian Health Service/Tribal/Urban Indian Health (I/T/U) Pharmacy
Primary
—
—
333600000X
Pharmacy
5301006253
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
2354455
—
MI
05
—
33205200
—
WI
Enumeration date
01/23/2007
Last updated
05/18/2021
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