Organization
PHS INDIAN HOSPITAL
Active
Other names
RED LAKE INDIAN HOSPITAL PHARMACY
Organization subpart
No
Provider details
NPI number
Authorized official
JAN THUNDER (BUSINESS OFFICE MANAGER)
(218) 679-0148
Entity
Organization
Contact information
Practice address
24670 HOSPITAL DRIVE, RED LAKE, MN 56671
(218) 679-0173
(218) 679-0189
Mailing address
4100 W. 150TH ST, LB: 95419, CLEVELAND, OH 44135
Taxonomy
Speciality
Code
Description
License number
State
332800000X
Indian Health Service/Tribal/Urban Indian Health (I/T/U) Pharmacy
Primary
2604653
MN
332B00000X
Durable Medical Equipment & Medical Supplies
—
—
3336C0002X
Clinic Pharmacy
—
—
3336S0011X
Specialty Pharmacy
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2046533
PK
—
05
—
476753500
—
MN
Enumeration date
02/28/2007
Last updated
01/19/2024
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