Organization
THE FOUNDATION FOR HEALTH CARE CONTINUUMS
Active
Other names
COUNTRY MANOR LTC PHARMACY
Organization subpart
No
Provider details
NPI number
Authorized official
BRIAN KELM (CEO)
(320) 258-8985
Entity
Organization
Contact information
Practice address
520 1ST ST NE, SUITE A, SARTELL, MN 56377-1274
(320) 255-0801
(320) 255-5158
Mailing address
520 1ST ST NE, SUITE A, SARTELL, MN 56377-1274
Taxonomy
Speciality
Code
Description
License number
State
3336L0003X
Long Term Care Pharmacy
Primary
262882
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2427739
OTHER ID NUMBER-COMMERCIAL NUMBER
—
Enumeration date
08/22/2006
Last updated
03/26/2010
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