Organization
ALTRU HEALTH SYSTEM
Active
Other names
FAMILY MEDICINE RESIDENCY PHARMACY
Organization subpart
No
Provider details
NPI number
Authorized official
DEREK GOEBEL (CHIEF FINANCIAL OFFICER)
(701) 780-1470
Entity
Organization
Contact information
Practice address
725 HAMLINE ST, GRAND FORKS, ND 58203-2819
(701) 780-6870
(701) 780-6878
Mailing address
725 HAMLINE ST, GRAND FORKS, ND 58203-2819
(701) 780-6870
(701) 780-6878
Taxonomy
Speciality
Code
Description
License number
State
333600000X
Pharmacy
—
—
3336C0002X
Clinic Pharmacy
Primary
PHAR477
ND
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2071404
PK
—
05
—
21082
—
ND
05
—
574155600
—
MN
Enumeration date
02/02/2007
Last updated
05/23/2024
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