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Organization
GRAND ITASCA CLINIC AND HOSPITAL
Active
Organization
GRAND ITASCA CLINIC AND HOSPITAL
Active
Parent organization
GRAND ITASCA CLINIC & HOSPITAL
Other names
Grand Itasca Pharmacy
Organization subpart
Yes
Provider details
NPI number
Legal business name
GRAND ITASCA CLINIC & HOSPITAL
Authorized official
JEAN MACDONELL (VP, CLINIC SERVICES)
(218) 999-1510
Entity
Organization
Contact information
Practice address
1601 GOLF COURSE RD, GRAND RAPIDS, MN 55744-8648
(218) 999-1885
(218) 999-1887
Mailing address
1601 GOLF COURSE RD, GRAND RAPIDS, MN 55744-8648
(218) 999-1885
(218) 999-1887
Taxonomy
Speciality
Code
Description
License number
State
333600000X
Pharmacy
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
288995200
—
MN
Enumeration date
01/09/2019
Last updated
01/09/2019
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