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Organization

PERHAM HOSPITAL DISTRICT

Active
Other names
PERHAM HEALTH HOSPITAL PHARMACY
Organization subpart
No

Provider details

NPI number
Authorized official
DUANE WALLACE RPH (DIRECTOR OF PHARMACY)
(218) 347-1571
Entity
Organization

Contact information

Practice address
1000 CONEY ST W, PERHAM, MN 56573-2102
(218) 347-1580
(218) 347-1652
Mailing address
1000 CONEY ST W, PERHAM, MN 56573-2102
(218) 347-1580
(218) 347-1652

Taxonomy

Speciality
Code
Description
License number
State
333600000X
Pharmacy
3336I0012X
Institutional Pharmacy
Primary
200303
MN
3336L0003X
Long Term Care Pharmacy

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
2045652
PK
05
211047400
MN
Enumeration date
01/30/2007
Last updated
06/30/2014
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