# PHARMACY DEPT. PHS INDIAN HOPSITAL

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1972644318
- **Authorized official:** KATHLEEN R DUDLEY (CREDITIALING COOR.)
- **Authorized official phone:** (218) 679-3912

## Contact information

- **Practice address:** HWY 1, BOX 497, RED LAKE, MN 56671
- **Practice address phone:** (218) 679-3912
- **Practice address fax:** (218) 679-0181
- **Mailing address:** HWY 1, BOX 497, RED LAKE, MN 56671
- **Mailing address phone:** (218) 679-3912
- **Mailing address fax:** (218) 679-0181

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 282N00000X | General Acute Care Hospital | — | MN | Yes |

## Other

- **Enumeration date:** 02/09/2007
- **Last updated:** 08/22/2020